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TRICARE Prime beneficiaries referral waiver period is over

WHITEMAN AIR FORCE BASE, Mo. -- A temporary referral waiver for TRICARE Prime beneficiaries ended June 30, 2018, and patients need to take action to continue receiving specialty healthcare.

The waiver allowed TRICARE West Region beneficiaries to bypass the review and approval process for most specialty outpatient care through the end of June.

Although the waiver program was initiated and managed through Health Net Federal Services, which provides health insurance via the military’s TRICARE program, the 509th Medical Group at Whiteman Air Force Base is working to help those who are affected, said Col. Chrystal Henderson, the 509th MDG commander.

“The Med Group wants to remind Team Whiteman that this short-term program has ended, as well as understand what this means for them and their families, and what steps they can take next,” Henderson said.
This update affects those enrolled in TRICARE Prime. The waiver allowed those beneficiaries to receive off-base medical care from authorized TRICARE network and non-network providers without paying out of pocket fees.

Continuing healthcare
Now, if beneficiaries would like to continue healthcare that was initiated during the waiver period, they will need to get a new referral from their primary care manager.

Otherwise, specialty healthcare received after June 30, 2018, could result in beneficiaries paying out-of-pocket expenses. This applies when non-emergency care is provided by an authorized-TRICARE provider without a referral. TRICARE pays for services only if the provider is TRICARE-authorized and the services are covered by TRICARE. Beneficiaries need to contact their primary care manager.

Approved beneficiaries were issued a waiver letter to use as authorization for covered outpatient specialty care during this period.

Now, to continue this healthcare, beneficiaries need to:
• Verify their referral and authorization requirement. This can be done at www.tricare-west.com. Click “authorizations” and then “is approval needed.”
Most specialty services require a referral. To identify which services require a referral, go to www.tricare-west.com.
• In some cases, beneficiaries’ doctors must submit a request for approval to Health Net Federal Services.
If beneficiaries seek healthcare without an approved referral if one is necessary, they will incur out-of-pocket expenses.
• Once beneficiaries have received a new approval from Health Net Federal Services, they may seek care from their specialty healthcare providers.

Base clinic offering support
New referrals for specialty care can be obtained through the Whiteman medical clinic’s appointment line at 660-687-2188; beneficiary counselors can be reached at this same number.

Additionally, the Medical Group hosts Coffee with the MDG Commander at 8:30 a.m. the first Monday of every month in the clinic’s pharmacy waiting area to address healthcare service-related questions and concerns. The sessions are also available on the Whiteman Medical Group’s Facebook page: www.facebook.com/Whiteman509MDG