Navigating referrals part of health care experience

  • Published
  • By Brian Smith
  • TRIWest Healthcare Alliance
TRAVIS AIR FORCE BASE, Calif. --  PHOENIX - After seeing a primary care manager, they may suggest to see a specialist. Maybe it's for an evaluation; maybe it's for a specific treatment.

Whether this is the first referral or the fiftieth, having all the information before making the appointment can save time and money. Quickly start managing the referral information by registering on TriWest.com.

What's a referral?

When care is needed that a primary doctor can't provide, they will issue a referral to see someone else. The request for a referral goes to TriWest Healthcare Alliance and TriWest processes the referral and matches needed care with a local network specialist when available. When living near a military installation with a medical clinic, and that medical clinic offers the specialty care, they may be assigned to the military clinic for care.

When the referral request is authorized, TriWest will let the patient know:

· The name and contact information of the network specialist

· The expiration date of the referral. If the appointment is not made within the time
allowed, the patient may have to go back to the primary doctor for a new referral.

Contact the network specialist and make an appointment. Network providers will submit claims to TriWest and send any results back to the primary doctor.

TRICARE Standard and TRICARE Extra plans don't require referrals or primary care managers. There are, however, higher out-of-pocket costs for care under those plans

How do I get my specialist's information?

First, register for a TriWest.com account,and receive an email when your referral is processed, usually within a day or two of the primary doctor submitting the request.

Then, log onto TriWest.com to view the specialist. Go to TriWest.com/Register.
A patient can also choose to get a letter with the specialists information, but that could arrive 10 days after the request is made.

Why is it important to know my assigned specialist?

If the patient doesn't go to a TRICARE network specialist, or the military clinic if they are assigned to go there, they could end up paying out-of-pocket for care.

To see network specialists nearby, visit the TriWest's Provider Directory. Find providers by specialty, location or name. Go to TriWest.com/ProviderDirectory when at a desktop or laptop, Use a mobile device to use the interactive provider directory when on the go, bookmark m.TriWest.com .