Frequently Asked Questions (FAQs)
Appointments & Referrals
I’m enrolled in TRICARE Prime at Kimbrough Ambulatory Care Center, why are my referrals for specialty care sent to other MTFs in the National Capital Region (NCR)?
TRICARE Prime functions similar to a civilian Health Maintenance Organization (HMO). Enrollees are assigned or choose a Primary Care Manager (PCM) who manages their care and refers to specialists when necessary.
Referrals from your PCM for specialty care are directed to the NETWORK of providers. Military Treatment Facilities within the NCR are considered NETWORK facilities and are the first choice considered for almost all specialty care referrals written from PCMs within the NCR. If the care your provider requested is not available due to capacity and/or capability within an MTF it is deferred to TRICARE East for assistance in finding a NETWORK civilian provider.
My Primary Care Manager placed a referral for specialty care services, what do I need to do?
When your Primary Care Manager submits a referral request to a specialty clinic, it is reviewed by the requested Specialty Clinic within the MTF before being approved. Your Primary Care Manager does not authorize or approve referrals or services.
To book your referral for specialty care you must first call the appointment call center at 301-677-8800 after two business days and select option 1 to schedule your specialty care appointment (Don’t delay).
If no appointments are available in MTFs within the NCR your referral will be deferred to TRICARE East to locate a civilian NETWORK provider. Once your referral is deferred to TRICARE East, you may call 1-800-444-5445 after 3 business days for the authorization number, name and location of the civilian network provider or you may wait for the authorization notice to arrive via mail.
Emergent and Urgent referral requests are coordinated provider to provider by your Primary Care Manager and the requested specialty along with assistance from the RMC and, if necessary TRICARE East.
If you are having problems with your referral or need additional assistance with your referral please call our RMC 301-677-8841. If your referral was deferred to TRICARE East and you have not received your authorization notice within 10 business days, please call 1-800-444-5445 for assistance. Please note you may register at humanamilitary.com to view/print your authorizations for civilian medical care.
What can I do if my referral is accepted by a Military Treatment Facility and I would rather see a provider in the civilian community?
Active duty family members, retirees, and retiree family members have several options. They may use the TRICARE Prime Point of Service option to seek non-emergent care from civilian providers and pay the TRICARE Prime Point of Service deductible and cost share, resulting in higher out of pocket expenses or they may disenroll from TRICARE Prime and use TRICARE Select. Beneficiaries requiring assistance understanding their benefit options and costs associated with each option may call 301-677-8982 to schedule an appointment with Kimbrough's Beneficiary Counseling and Assistance Coordinators.
How can I request a second medical opinion?
To avoid unnecessary out of pocket expenses under the Point of Service Option, it is best to coordinate a request for a second medical opinion through your assigned Primary Care Manager.
Note for ADSM: Due to deployability and fitness-for-duty issues, active duty service members are required by DoD policy to remain enrolled in TRICARE Prime and are required to have a referral and prior authorization for all non-emergent care rendered from civilian sources. Service members seeking non-emergent care from civilian sources without proper authorization do so at their own risk.