Understanding the Referral Requirement for Tricare Reserve Select Enrollment

Does Tricare Reserve Select Require a Referral?

The Tricare Reserve Select (TRS) program is a popular healthcare option for members of the Selected Reserve of the U.S. military. One common question among TRS beneficiaries is whether they require a referral to see a specialist. In this article, we will delve into this topic and provide you with the necessary information to understand the referral process under the TRS program.

Understanding Tricare Reserve Select

Before we address the referral requirement, let’s first understand what Tricare Reserve Select is. TRS is a health insurance program designed to provide coverage for members of the Selected Reserve of the U.S. military, including the Army Reserve, Navy Reserve, Marine Corps Reserve, Air Force Reserve, and Coast Guard Reserve. It is a self-funded program, meaning that the Department of Defense (DoD) administers the program but does not directly pay for the services.

Referral Requirements for Tricare Reserve Select

Now, let’s address the main question: Does Tricare Reserve Select require a referral? The answer is yes, in most cases. Beneficiaries of TRS are generally required to obtain a referral from their primary care manager (PCM) before seeing a specialist. This referral is necessary to ensure that the specialist’s services are deemed medically necessary and to facilitate the coordination of care.

However, there are some exceptions to this rule. For example, TRS beneficiaries may not need a referral for:

– Emergency care
– Preventive care services
– Routine physical exams
– Mental health services
– Routine eye exams and glasses
– Routine dental care

It is important to note that the specific requirements may vary depending on the type of care and the healthcare provider. Beneficiaries should always consult their PCM or the TRS program guidelines to determine whether a referral is needed for a particular service.

How to Obtain a Referral for Tricare Reserve Select

If a referral is required, TRS beneficiaries can obtain one by following these steps:

1. Schedule an appointment with their PCM.
2. Discuss the need for a referral with their PCM during the appointment.
3. If a referral is deemed necessary, the PCM will provide the beneficiary with a referral form.
4. The beneficiary can then use the referral form to schedule an appointment with the specialist.

It is crucial to obtain the referral in a timely manner, as some specialists may require advance notice before scheduling an appointment.

Conclusion

In conclusion, Tricare Reserve Select generally requires a referral for specialist care. However, there are exceptions to this rule, and beneficiaries should consult their PCM or the TRS program guidelines to determine the specific requirements for their situation. By understanding the referral process, TRS beneficiaries can ensure they receive the necessary care while adhering to the program’s guidelines.