There are times when you will need to see a specialist for a diagnosis or treatment that your PCM cannot provide. Your PCM will provide referrals to access services from specialty providers and will coordinate the referral request with Humana Military, when necessary. If you receive specialty care without a referral from your PCM, you will be utilizing the POS option, resulting in higher out-of-pocket costs. See the TRICARE: Summary of Beneficiary Costs flyer to learn about POS fees.

Call 1-800-444-5445 to learn about Humana Military's requirements, as they may change periodically. 

If you live near an MTF and are referred for specialty care, inpatient admissions, or procedures requiring prior authorization, Humana Military will attempt to coordinate your care at the MTF first. When the services are not available at the MTF, the care will be coordinated with a TRICARE network provider.

If your PCM refers you to a specialist who would like to refer you to another specialist, the specialist will need to contact your PCM. Your PCM or the specialist will contact Humana Military to obtain authorization for additional specialty care, when necessary.

Non-active duty TRICARE Prime enrollees who are referred by their PCM for specialty care at a location more than 100 miles (one way) from the PCM’s office may be eligible to have “reasonable travel expenses” reimbursed by TRICARE. Reasonable travel expenses are the actual costs incurred while traveling, including meals, gas/oil, tolls, parking, and tickets for public transportation (i.e., airplane, train, bus, etc.). You must submit receipts for expenses above $75.

TRICARE will use government rates to estimate the reasonable cost. You are expected to use the least costly mode of transportation. TRICARE will reimburse the actual costs of lodging (including taxes and tips) and the actual cost of meals (including taxes and tips, but excluding alcoholic beverages) up to the government rate for the area concerned.

In some cases, a non-medical attendant may also be authorized for travel reimbursement. The non-medical attendant must be a parent, guardian, or another adult family member 21 years of age or older.

To qualify, you must have a valid referral and travel orders from a TRICARE representative at your MTF (if enrolled to an MTF PCM) or from the TRICARE Regional Office (TRO) (if enrolled to a civilian PCM). You should obtain the travel orders before traveling. Contact your local MTF or TRO travel representative if you think you may qualify for this travel reimbursement.