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Thread: Tricare help?

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    #1

    Tricare help?

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    I need to know if I have to have a referral to go to a developmental pediatrician, while on standard Tricare. I need to have my DS's medical records of his disability updated. So, I can get the EFMP paperwork in before DH is done with all the training.

    Also Because I have two children with significant problems, am I better off changing to Prime? Seeing I'm an hour away from Hill would that be a bad thing?
    Valerie

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    #2
    If you or your doctor requested a referral you should be able to call Triwest and they can look it up for you.
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    #3
    I prefer Prime than standard, because you live that far from Hill, tricare will let you see a dr offbase. When we got her we actually got a choice if we wanted to see a dr on or off base and that is with Prime. But as far as a referral is concerned, I am pretty sure you will need one from a PCM before you see the behavioural pead


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    #4
    I'd choose Prime. I haven't had any major complaints with my care. I love not having to pay a dime for my medical care.

    Sometimes it can depend on how many miles you live from your nearest MTF. I believe those living w/in 40 miles of the MTF have to go there, unless given a referral to see a civi.

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    #5
    If you are on standard NOW, you do not need a referral. If you go to Prime, then you will need a referral.

    I am on standard and I don't get a referral for anything. Except major testing has to be pre-authorized.
  6. Pass the Chocolate
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    #6
    Ditto...on Standard you make your own decisions. The developmental ped might not see you without any recommendations,etc though just because they tend to be hard to get into in my experinence.

    Going on Prime means going to your PCP and asking for a referral...waiting...setting up appt...waiting...then maybe seeing the developmental ped.

    Prime would be "free" though. How urgent is it?
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    #7
    It's not really urgent, It's just I need to get the EFMP papers done. Of course his PCP said I need to get his developmental ped to fill out the papers as he knows more. The developmental ped said he'd fill them out he just need to see him. So... ya know!
    Valerie

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    #8
    You're on standard now? It sounds like you already see the developmental ped? Then just make an appt w/the developmental ped for the paperwork. I am pretty sure that's how it works (I'm still figuring out Standard myself LOL.)
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    #9
    I prefer Standard since I am having medical issues. It's definitely worth the money for where I live now since our base has basically no on base medical and never refers out hardly and it takes so long to get an appt. I also hate waiting a week for referrals when stuff is wrong with me. You should be able to just make an appt with the pedi and if your concerned call tricare's number and double check.
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    #10
    Quote Originally Posted by BubMunkeyBles View Post
    I prefer Standard since I am having medical issues. It's definitely worth the money for where I live now since our base has basically no on base medical and never refers out hardly and it takes so long to get an appt. I also hate waiting a week for referrals when stuff is wrong with me. You should be able to just make an appt with the pedi and if your concerned call tricare's number and double check.
    Yep. Me too.

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