Get medical referrals or pay bills yourself Published March 27, 2012 By 341st Medical Group MALMSTROM AIR FORCE BASE, Mont. -- Members who seek urgent care or specialty care without a referral from their Primary Care Manager and an authorization from TriWest are going to get a bill in the mail for the services rendered. A PCM determines whether a member needs to be seen by a civilian specialist. If they do, their PCM will write a referral for that care. The specialty care referral is sent to TriWest Healthcare Alliance. TriWest will review the referral and determine if the care is medically necessary. If they determine it is, they will issue an authorization for that doctor visit. If Airmen see a civilian provider without this authorization, they are financially responsible for that care. In accordance with TRICARE Operations Manual 6010.56-M, [Chapter 8, Section 5, para 1.3], Airmen in need of urgent care must call for a referral from a PCM prior to going to an urgent care center. The Malmstrom Clinic's main appointment phone line is 731-4MED (4633). If someone calls for an urgent care appointment and one is not available within 24 hours, the access standard set by Congress, they will be given the opportunity to request a referral to seek care from a civilian facility. However, if an appointment is available at the military treatment facility within the next 24 hours, they will be scheduled for that appointment, and no referral for urgent care will be generated. If active duty members go to a specialist or urgent care facility without having a referral and authorization, they will be required to pay the entire bill. A family member, retiree or retiree family member enrolled in TRICARE Prime who go to a specialist or urgent care facility without an authorization, they will be required to meet an annual deductible and then pay a 50 percent cost-share based on the amount TRICARE allows providers to bill for services (point of service option). No referral is needed if it is a true emergency (i.e., risk of loss of life, limb or eyesight). For an emergency, call 911 or proceed to the nearest emergency department. Save time and money by signing up for electronic QuickAlert text and email notifications. TriWest will immediately send enrolled members QuickAlert notifications when an authorization is processed for so they can make their specialty care appointment in hours, instead of waiting for days on a mailed letter. For more information, contact Renae Hutchins at 731-4117 or 1st Lt. Stephen Meyers at 731-3805.