Health & Safety

August 3, 2012

Why your referral matters

by Brian P. Smith
TriWest Healthcare Alliance

You went to your primary care manager and she suggested you go see a specialist. Maybe it’s for an evaluation; maybe it’s for a specific treatment. You just know you need to make another appointment and you want to make it quickly.

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

What’s a referral?

When you need care that your primary doctor can’t provide, you will get a referral to see someone else. The request for a referral goes to TriWest Healthcare Alliance and TriWest processes the referral and matches your needed care with a local network specialist (when available). If you live near a military installation with a medical clinic, and that medical clinic offers the specialty care, you may be assigned to the military clinic for care.

When your referral request is authorized, TriWest will let you know:

  • The name and contact information of your network specialist
  • The expiration date of your referral (if you don’t make your appointment within the time allowed, you may have to go back to your primary doctor for a new referral).

You contact the network specialist and make your appointment. Network providers will submit claims to TriWest and send any results back to your 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?

Register for a TriWest.com account, and you will receive an email when your referral is processed – usually within a day or two of your primary doctor submitting the request. Then, you can log into your TriWest.com account to view your specialist. Go to TriWest.com/Register.

You can also choose to get a letter with your specialist information, but that could arrive 10 days after the request is made.

Why is it important to know my assigned specialist?

If you don’t go to a TRICARE network specialist (or the military clinic if you’re assigned to go there), you could end up paying out-of-pocket for your care.

If you’re wondering if there are network specialists near you, you can use TriWest’s Provider Directory. Find providers by specialty, location or name. When you’re at your desktop or laptop, go to TriWest.com/ProviderDirectory. When you’re on the go, bookmark TriWest.com in your mobile device to use the interactive provider directory.




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