Tricare Help: Referral can’t ensure coverage - Military Health, Tricare programs - Military Times

Tricare Help: Referral can’t ensure coverage

James E. Hamby Jr. takes your questions each week on Tricare-related issues.

Q. My doctor says I need laser surgery on my eyes, but he does not do that kind of procedure and recommends a different doctor. Mine is a Tricare doctor, so, if he orders it, will it be covered by Tricare?

A. Consider these factors:

• First, is the surgical procedure covered by Tricare? The laser procedure to improve visual acuity called Lasik is not covered by Tricare. Conversely, there are other laser-involved procedures, such as some to treat retinal detachment, that may be covered.

• Second, in order to be covered, a medical or surgical service must be medically necessary and appropriate for the particular patient’s diagnosis, symptoms or history. Before payment, Tricare would need to ascertain those facts in your particular case.

A Tricare-authorized physician recommending or ordering a medical or surgical service does not, of itself, make the service medically necessary, appropriate or covered by Tricare. Your Tricare doctor might recommend something that Tricare is not allowed to cover in your particular case.

• Third, although the referring physician may be Tricare-authorized, his referral does not make the specialist a Tricare-authorized provider. Tricare may not pay for the services of any provider who is not registered with Tricare as an authorized provider.

I suggest that you contact your Regional Tricare Office for more, and official, information.

Q. Like all the men on both sides of my family, I had thick hair when I joined the Army. Now, after multiple deployments, immunizations and wartime conditions, my hair is getting thinner. Will Tricare help pay for Bosley hair restoration for me?

A. Tricare benefits are governed by federal law and regulation. Tricare cannot pay for cosmetic procedures done only for psychological reasons, and it cannot pay for hair transplants unless your thinning hair is the result of a malignant disease.

If you believe your hair loss is a service-connected condition and you are due compensation, consider filing a claim with the Veterans Affairs Department.

You may have to prove somehow that your hair loss is due to your military service and not merely the passage of time.

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Write to Tricare Help, Times News Service, 6883 Commercial Drive, Springfield, VA 22159, or e-mail tricarehelp@militarytimes.com. In e-mail, include the word “Tricare” in the subject line and do not attach files. Get Tricare advice anytime at our blog.