How Do I Change My Doctor with Tricare?
Changing your doctor with Tricare is generally a straightforward process, but understanding your plan’s specific rules is essential. Here’s how to navigate the system and ensure a smooth transition to a new primary care manager (PCM).
Understanding Tricare Plans and PCMs
Tricare offers various plans, each with different rules about choosing and changing doctors. The key player in managing your healthcare is your Primary Care Manager (PCM). This doctor is your main point of contact for medical care and often requires referrals for specialists. Understanding your plan and its PCM requirements is the first step in how do I change my doctor with Tricare?
- Tricare Prime: Requires you to select a PCM. This plan typically has lower out-of-pocket costs, but you’ll generally need a referral to see a specialist.
- Tricare Select: Allows you to see any Tricare-authorized provider without a referral, but your out-of-pocket costs might be higher. You don’t select a PCM under Tricare Select.
- Tricare US Family Health Plan (USFHP): Is available in specific geographic areas and provides care through networks of community-based, not-for-profit health care systems. Enrollees select a PCM within the USFHP network.
- Tricare for Life: Is Medicare-wraparound coverage for beneficiaries eligible for both Tricare and Medicare. Beneficiaries can see any Medicare provider and do not select a PCM.
Choosing the right PCM is crucial. Consider factors like:
- Location: Is the doctor’s office conveniently located?
- Specialty: Do they have expertise in areas relevant to your health needs?
- Availability: Are they accepting new patients? What are their hours?
- Patient Reviews: What do other patients say about their experience?
Step-by-Step Guide: Changing Your Doctor with Tricare
The process of how do I change my doctor with Tricare? depends on your specific plan. Here’s a general outline:
- Identify a New Doctor: Research and find a new PCM who is accepting new patients and participates in the Tricare network. Contact the doctor’s office to confirm they are a Tricare provider and can accept you as a patient under your specific plan.
- Contact Your Tricare Regional Contractor: Your regional contractor manages your Tricare benefits. You can find their contact information on the Tricare website (tricare.mil). The three regional contractors are:
- East Region: Humana Military
- West Region: Health Net Federal Services
- Overseas: International SOS
- Request a PCM Change: You can usually request a PCM change online, by phone, or by mail. The method depends on your regional contractor.
- Provide Required Information: Be prepared to provide information such as your Tricare enrollment information, the name and address of your current PCM, and the name and address of your desired new PCM.
- Confirmation: Once your request is processed, you will receive confirmation of your PCM change. This confirmation might come via email or mail, depending on your regional contractor’s procedures.
- Verify Enrollment with New PCM: Contact the new PCM’s office to confirm your enrollment is active and to schedule an appointment.
Common Mistakes and How to Avoid Them
- Failing to Confirm Network Participation: Always verify that the new doctor participates in the Tricare network before making the change. Seeing an out-of-network provider can result in significantly higher out-of-pocket costs.
- Changing Without a Valid Reason: While you generally don’t need a specific reason to change your PCM, frequent changes might raise questions with Tricare. Consider contacting your regional contractor if you anticipate needing to change PCMs frequently.
- Not Updating Referral Information: If you have existing referrals from your previous PCM, they may no longer be valid. Ensure you obtain new referrals from your new PCM as needed.
- Ignoring Plan-Specific Rules: Remember that different Tricare plans have different rules. Always consult your plan handbook or contact your regional contractor for clarification.
Using the Tricare Website
The Tricare website (tricare.mil) is a valuable resource. You can use it to:
- Find a participating doctor.
- Access your regional contractor’s contact information.
- View your plan’s benefits and rules.
- Manage your enrollment.
- Download forms.
Frequently Asked Questions (FAQs)
How often can I change my PCM with Tricare Prime?
You can generally change your PCM with Tricare Prime as often as you need to, provided you have a valid reason and follow the correct procedures. However, making frequent changes may warrant scrutiny from your regional contractor.
Can I change my doctor if I am enrolled in Tricare Select?
No, because Tricare Select does not require you to select a PCM. You can see any Tricare-authorized provider.
What information do I need to change my doctor with Tricare?
You’ll need your Tricare enrollment information, the name and address of your current PCM (if applicable), and the name and address of your desired new PCM. Having your beneficiary number readily available is also helpful.
How long does it take to change my PCM?
The processing time for changing your PCM can vary, but it typically takes a few days to a week. It’s best to submit your request well in advance of any scheduled appointments.
Can I change my PCM online?
Yes, in most cases, you can change your PCM online through your regional contractor’s website. Check your regional contractor’s website for specific instructions.
What if I don’t like my new PCM?
If you are unhappy with your new PCM, you can request another change. Document your concerns and consider discussing them with your regional contractor.
Can I change my doctor if I am overseas?
The process for changing your doctor while overseas is similar, but you’ll need to contact the overseas regional contractor, International SOS. They can provide specific guidance and assistance.
Does it cost anything to change my PCM with Tricare?
No, there is no cost to change your PCM with Tricare. The service is included in your Tricare benefits.
What is a referral, and why do I need one?
A referral is an authorization from your PCM to see a specialist. Tricare Prime typically requires referrals to control costs and ensure coordinated care.
Can I keep my existing referrals when I change doctors?
No, referrals are generally tied to your PCM. You will need to obtain new referrals from your new PCM.
What happens if I see a specialist without a referral when one is required?
If you see a specialist without a required referral, you may be responsible for the full cost of the visit. Always verify referral requirements with your Tricare plan and PCM.
How do I find a Tricare-authorized doctor?
You can use the Tricare provider directory on the Tricare website (tricare.mil) or contact your regional contractor for assistance. They can help you find doctors who participate in the Tricare network.