July 16 —
Q: We live in Portales. Why can’t we use off-base medical care facilities?
A: Thank you for the question and giving us an opportunity to explain the TRICARE Prime benefit. The Military Treatment Facility enrollment area and TRICARE guidance state that individuals within 30 minutes from the MTF are to be assigned to the local military facility. TRICARE determines the 30-minute drive time by using an electronic mapping system. Cannon military members and their families living in Clovis and Portales meet the 30-minute drive time stipulation and are assigned to the Cannon MTF.
Prime Service Area guidelines established with our managed care support contractor, TRIWEST, state that all family members of active duty personnel living within the 30-minute radius must enroll to the MTF. This facilitates your primary care manager’s ability to provide continuity of medical care to include immunizations, prescriptions, ancillary services, etc., all within one location.
Some individuals having complex medical care requirements may indicate the necessity to have a civilian PCM. The chief of medical staff thoroughly reviews these complex cases and then proves those whose medical care exceeds our capabilities to have a civilian PCM. As a beneficiary you do have the option of enrolling with a civilian PCM using the TRICARE Standard benefit. TRICARE Standard does offer the benefit of enrolling with any local provider who accepts TRICARE, but does require you to pay a cost-share, deductible and you will not be able to claim travel reimbursement expenses should you be referred to a specialist more than 100 miles away.
During our research we found that, due to the beneficiary size of regions in the greater Florida Panhandle, MTFs authorized individuals living within certain areas to use a civilian PCM for a certain period of time. Military treatment facility commanders do have the option to request beneficiaries to use other local TRICARE providers when facilities are unable to meet the access to care guidelines or when beneficiaries have greater medical needs. Here, however, the 27th Special Operations Medical Group does have the ability to see you and your family as established by regulatory TRICARE guidelines.
We look forward to serving you, your family and all the military members of our Portales and Clovis communities.