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Tue Jan 24, 2017
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What happens if my family member, who is enrolled in TRICARE Prime, uses a non-network provider of care without getting an advance authorization from the regional military service center?  
A designated health care finder at the local TRICARE service center authorizes referrals for routine or specialty care. Care received that has not been referred by the Primary Care Manager (PCM) is only payable under the point-of-service option (with the exception of emergency care). The following cost shares and deductibles apply: fiscal year deductible for outpatient claims is $300 per individual or $600 per family; beneficiary cost share for inpatient and outpatient claims is 50% of the covered costs after the deductible has been met.
Keywords: TRICARE, medical care, Insurance

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