The Medical Referral Process

Photo By Jason Bortz | HM1 Taj Herbert with Naval Hospital Pensacola’s Physical Therapy Department provides care to a patient on Sept. 4. Physical therapy is one of several specialty services that TRICARE beneficiaries may receive a referral for at NHP.  

PENSACOLA, FL, UNITED STATES

09.19.2014

Story by Jason Bortz 

NMRTC Pensacola

NAVAL HOSPITAL PENSACOLA, Fla. -- As robust as the services available at Naval Hospital Pensacola are, TRICARE Prime beneficiaries may at times be referred to a specialist outside of the hospital.

It’s important that TRICARE beneficiaries understand the referral process to avoid unnecessary delays with care and potential costs.

First and foremost, NHP has the privilege to see all beneficiaries enrolled at the hospital prior to referring them to a civilian provider for specialty care such as physical therapy, orthopedic surgery and dermatology. TRICARE Prime Network beneficiaries with a civilian primary care manager who reside within 60 minutes of NHP may also be referred to the hospital for specialty care. If the hospital has the capacity to perform the services in an appropriate amount of time, it is best for beneficiaries to be seen at NHP.

“It is in the best interest of our patients to receive as much care here as possible,” said Cmdr. Kedric Webster, director of surgical services, NHP. “The staff here is all part of the military family, so we understand and know our patients best. Plus, all of the specialty clinics have direct access to a patient’s primary care manger if they are enrolled here.

The staff of the specialty clinics work side by side with the primary care managers to coordinate the appropriate care needed for our patients.”
For services that require surgery, such as orthopedics, NHP is equipped with state-of-the-art operating rooms and has highly-trained staff who can perform a variety of services.

“Military doctors get the same board certification training that civilian doctors get,” said Webster, “but military doctors and surgeons also bring a plethora of education and knowledge that they have acquired from multiple locations throughout their careers. We work together as a team to provide the best care possible to our patients.”

If the hospital is unable to perform a service, beneficiaries will receive a referral to a TRICARE approved provider and all referrals must be preapproved by TRICARE. TRICARE beneficiaries who see a civilian provider without an authorization could be charged a $300 deductible and 50 percent of the cost of the visit.

Once a beneficiary receives a referral, it is the responsibility of the beneficiary to manage the referral, which could include multiple approved visits. If the approved number of visits expires, beneficiaries need to contact their primary care manager or Medical Home Port Team to request additional appointments. Referral requests can take up to 10 business days to be approved by TRICARE and beneficiaries need to wait for the referral to be approved before continuing care.

“When a beneficiary is granted a referral from their PCM for a specialist outside of Naval Hospital Pensacola, they will receive a letter in the mail from TRICARE explaining the referral,” said Lt. Carlos Linomontes, department head for Utilization Management, NHP. “The letter will contain who the referral is with and how many appointments can be made with that referral. It is important that beneficiaries read and understand the letter to avoid confusion. If they have questions about their referral, they can contact their Medical Home Port Team, PCM, TRICARE or our Health Benefits Office.”

Referral tracking can be done through www.tricareonline.com or by calling TRICARE at 1-800-444-5445. The Health Benefits Office at NHP can also assist and is available at 850-505-6709.

• Date Taken: 09.19.2014
• Date Posted: 09.20.2014 22:56
• Story ID: 142810
• Location: PENSACOLA, FL, US