TRICARE and You – Losing your provider or network doctor
Posted by LT Sarah Janaro, Monday, January 9, 2017
This blog is the most recent in a series helping members of the Coast Guard family understand how to use their TRICARE benefits. The blog series will continue every Monday, right here on Coast Guard All Hands.
Written by Cmdr. Paul Fawcett, chief of Medical Administration for Coast Guard’s Office of Health, Safety and Work-Life
For any number of reasons you may lose access to your TRICARE doctor. Your provider may elect to no longer accept TRICARE, may retire, move, or leave medical practice. Regardless of the reason, the result is that you and your dependents may no longer have a doctor.
What to Do –
Losing access to your provider can present problems, magnified if you are in a remote area where care can be difficult to find in any event. As soon as you find that you can’t see your assigned doctor you should take immediate steps to get a new one. You should not wait until you need an appointment, finding a new provider may take time, and even if you find one right away you may have to wait for an appointment. Here are some steps to take to help find a new doctor:
- Ask your old provider or practice if they can recommend another doctor that accepts TRICARE and may accept patients.
- Network with other military families at your unit or nearby units as to what TRICARE providers they see and if they would recommend them. Contact recommended providers to see if they would accept you as a patient.
- Search the directory of providers on the TRICARE website for a list of available providers in your area. Select providers and begin calling to see if they will accept new providers.
- If after you’ve attempted the above steps and still don’t have a provider, you should contact your regional TRICARE contractor for assistance. You should not accept simply being given a new list if you have already worked through the online list with no success. You should ask the customer service representative for assistance with finding a doctor.
You can reach the regional contractors at:
1. North-Health Net, 1-877-TRICARE (1-877-874-2273), https://www.hnfs.com/
2. South-Humana Military, 1-877-249-9179, https://www.humanamilitary.com/
3. West-United Healthcare, 1-877-988-WEST (9378), https://www.uhcmilitarywest.com/
* If you’ve worked with the contractor and you still do not have a doctor active duty members and families should notify their command. This is important so that your problem can be elevated for help and also so that it can be determined if the problem is extensive or limited to one family or area.
What if I need care while I’m waiting?
The process of finding a new provider may take time, and when you find one you may have to wait for a new patient appointment. If you need care in the mean time you can visit the Emergency Room for emergent issues. Active duty family members are authorized two unreferred visits to a network urgent care center per year; you are encouraged to use those as well. Active duty members can get referrals to urgent care centers from their duty corpsman or medical staff.
What should Commands do?
For Commands in remote areas, loss of a single provider can cause immediate access to care problems. You should immediately take steps to address the issue:
- Find out from the crew how many members and dependents are affected and what steps they’ve taken to find new providers. Create a list of affected members.
- Notify your Independent Duty Health Services Technician, clinic administrator, and regional practice manager that there is an access to care issue affecting your crew and the scope of the problem. Your list of affected members will be key to informing your support network of the nature of your difficulties.
- You should encourage all affected members to contact the regional contractor so that your issue is recorded.
Your regional practice manager, along with the HSWL SC staff, will work with the contractor to resolve your access to care issues.
For TRICARE issues you may also contact the CG health benefits assistance line at 1-800-9-HBA-BBA or at CGHBA@uscg.mil.