As plentiful as the services available at Lyster Army Health Clinic are, TRICARE beneficiaries may at times be referred to a specialist outside of the clinic.
It's important for TRICARE beneficiaries to understand the referral process to avoid unnecessary delays with care and potential costs.
"It is in the best interest of our patients to receive as much care here as possible," said Lt. Col. Jon Baker, LAHC Commander.
"The staff here is part of the military family, so we understand our patients' needs."
There are two types of referrals, specialty and diagnostic.
Your provider places a referral request into the LAHC Health System for services which are outside of the scope of what Lyster can provide inside the primary care clinic.
Diagnostic testing can include, but is not limited to: bone scans, sleep studies, Holter monitors, or mammograms which are scheduled thru the Patient Service Center.
Specialty services can be for such services as allergy, dermatology, neurology, or endocrinology needs.
"Once a request is placed by your provider, it can take up to ten business days before Tricare approves or denies the request. If the specialty service provider is located within Lyster (optometry, physical therapy or nutrition care) you will receive a call from that department to schedule an appointment," said Shannon Vickery, Chief of Managed Care Operations at LAHC.
Patients will receive a notice in the mail from Tricare with the decision regarding their referral. They will either be authorized or denied, and a justification will be listed.
"When a beneficiary is granted a referral from their Primary Care Manager for a specialist outside of Lyster, they will receive a letter in the mail from TRICARE explaining the referral," said Vickery. "The letter will contain who the referral is with and how many appointments can be made with that referral. It is important that beneficiaries read and understand the letter to avoid confusion."
If you need to change the specialty provider listed, call Tricare at the number listed or if you need to repeal your denial, patients should follow the directions sent to you with the denial.
Your specialty provider should be able to see you within 28 days, if they cannot, a patient should call Tricare and specialists will help locate a new provider for you. Lyster no longer has representatives for Tricare located in the clinic. The Patient Service center can only print off a copy of your referral if you are unable to access a printer.
If you have seen your specialty provider and would like a second opinion, you will need to contact your PCM by calling the patient appointment line, and leave your Provider's team nurse a message, providing them with the name of the Tricare approved specialty provider whom you would like to see. Your PCM will enter a referral for you to obtain the second opinion. You will then need to wait the ten business days for Tricare's response.
To check the status of your referral or to print it off earlier than the mail service, visit online at www.humanamilitary.mil
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