Do Parents Need Prior Authorization for Services?
No prior authorization or referral is required for the majority of mental health care services. This allows a parent to directly select and schedule services with any TRICARE authorized/in-network provider. When using an out-of-network provider, higher costs will likely be incurred by the parent. An important exception is that prior authorizations are required for psychoanalysis services, outpatient treatment for substance use disorder provided by a rehabilitation facility, and for inpatient mental health care (additional exceptions and notes on this pertaining to emergency care are detailed below). This information is true for all TRICARE plans, including Prime, Select, and Reserve Select.
If a child is experiencing a mental health emergency (meaning they are at risk of harming self and/or others), no prior authorization or referral is required to access emergency services. Once a child is admitted, the parent will be asked to contact their regional plan provider within 24 hours or the next business day (required to be reported within 72 hours).
What Does TRICARE Cover?
TRICARE covers a wide variety of mental health services, which includes treatment provided in outpatient, inpatient, residential, and partial hospitalization settings. Services include but are not limited to treatment for:
- Autism Spectrum Disorder (including Applied Behavior Analysis and psychological services)
- Eating disorders
- Gender dysphoria
- Psychological testing (this is not covered for academic placement purposes)
- Substance use disorder treatment
- Medication management
- Psychotherapy services as individual, group, and/or family treatment.
- Military OneSource is a DOD-funded resource that provides 24/7 support to Service Members and military families in the areas of moving and transition support, financial support, health and wellness, and mental health (to include referrals for free counseling services).
- The TRICARE Nurse Advice line can be contacted via telephone, web chat, and video chat, with instructions on how to contact a nurse both domestically and internationally.
For more information on covered services, please reference this comprehensive list.
Co-payments may be required depending on the TRICARE plan, sponsor’s status, and date when sponsor entered service. For a current breakdown of co-payments for mental health care services, click here to access TRICARE’s cost-share tool, which provides information about fees in 2020.
In addition to the flexibility provided by TRICARE for families to choose providers without prior authorizations (for exceptions, see above), many military installations also have Departments of Behavioral Health or Departments of Social Work with capacity to provide mental health services to children and adolescents. For example, on some Army installations, there are specific Child and Family Behavioral Health Services (CAFBHS) provided on post. For some families, there is added convenience to receiving mental health services directly through the installation medical center.
Where Can Parents Find Additional Support?
While navigating a child’s insurance benefits in regard to mental health care (and any other additional health needs), additional support and advocacy can be very helpful. The following are resources that could further assist a parent:
With health insurance directly connected to federal policy and regulation, TRICARE coverage and procedures are subject to change. Hopefully, this overview is a helpful starting point for connecting a child with the appropriate mental health services.