Tricare Prime: Tips for Non-Network Provider Referrals
Written by Katrina Crosby, Director of Business Operations
If you’ve ever tried to get a non-network referral with Tricare Prime, you know it can feel like you’re asking for a golden ticket. The system is designed to keep you in-network, and the first answer you’ll usually hear is “no.” But here’s the thing: no isn’t always the end of the story. I’ve seen plenty of families make it happen—it just takes persistence and a little strategy.
Don’t Just Ask—Show Why
When you sit down with your primary care manager (PCM), don’t simply say, “Can I see someone out of network?” That almost guarantees a rejection. Instead, show why your choice makes sense. Maybe the providers in-network can’t see you for two months or are located too far from you. Maybe the specialist you want has training that others don’t. Or maybe you’ve already built trust with this provider and switching would derail progress. The more specific you can be, the stronger your case.
Keep Notes Like a Lawyer
One of the most effective tricks I’ve seen is keeping a little “Tricare log.” Every time you call a network provider, jot down the date, time, who you spoke with, and when their next available appointment is. If you end up with a list of wait times stretching six to eight weeks out, you suddenly have proof—not just frustration—that the network can’t meet Tricare’s own access standards. That proof carries weight. Name Names If you want a referral to Crescent Counseling, say exactly that. Don’t leave it vague. If you just ask for a therapist or specialist outside the network, it’s too easy for the system to shuffle you somewhere else. Specificity keeps your request pointed where you want it.
Don’t Be Afraid to Push Back
Even when your PCM puts in a request for a non-network provider, Tricare may switch it to an in-network provider with or without informing you or your PCM. This can understandably be very frustrating. The good news is, I’ve seen many clients have success with getting this changed. The trick is to call Tricare directly and explain the same information you gave your PCM—why the non-network provider is the best (or only) option. Be ready to call more than once, and don’t hesitate to ask for a manager if the first rep can’t help. If you want to avoid Point-of-Service (POS) fees and get your care started sooner, this persistence can pay off. Another approach I’ve seen work is starting care with the provider without a referral and then requesting one later under “continuation of care.” The catch is that you’ll be responsible for POS (Point-of-Service) fees for those first visits. But once Tricare sees you’re already established with that provider, they’re often more willing to approve the referral going forward. Whichever route you take, the key is persistence. The first answer you get isn’t always the final word.
The Takeaway
I know the referral process with Tricare Prime can feel like a brick wall, but I’ve also seen that wall move when people stay persistent. If you’re clear, specific, and willing to keep asking, you stand a much better chance of getting the provider you actually want—not just the one the network wants to give you.