Unapproved medical care could cost you Published Jan. 7, 2016 By Senior Master Sgt. Jill LaVoie JBER Public Affairs JOINT BASE ELMENDORF-RICHARDSON, Alaska -- In the past few months, the 673d Medical Group has seen a spike in the number of unauthorized health care claims, due to military members receiving unapproved medical care off base. These unauthorized claims could result in military members paying out of pocket for medical care. "The confusion often stems from the verbiage that hospitals and clinics use. Sometimes companies say 'no standard out of pocket costs.' This doesn't mean free; someone still has to pay. Those companies collect insurance information from the patient and then they attempt to collect [payment for] those services from TRICARE," said Air Force Maj. Mark Sabroski, 673d Medical Group Tricare Operations and Patient Administration Flight commander. "Those claims get denied for payment - rightfully so, because there is no prior authorization for that care. At that point it's up to the company downtown if they are going to absorb that or turn around and bill the patient." Some of the bills Sabroski has seen reach nearly $5,000. To prevent patients from being responsible for these costs, TRICARE Prime patients must receive authorization. "With any medical issue, the first thing you should do is make an appointment with your primary care manager," Sabroski stressed. "Your primary care provider will examine you, and if you require specialty care, they will put a referral in the system for specialty care. If we have the capability, then we will book you within the medical group with one of our specialty clinics. If we don't have the capability, then we will defer that referral to the network." If they are referred to the network, patients will receive notification from United Health Care that they have authorized care at a civilian provider via the mail. Often, patients will also receive a call from the civilian provider to schedule care, however they should ensure the care is authorized before receiving care. Obtaining authorization doesn't only prevent military members from paying out of pocket; it also ensures it doesn't cost them money later. "Receiving unauthorized care could affect their VA disability status," said Maria Hughes, 673d Medical Group benefits advisors and debt collection officer. For instance, if the VA determines a condition or injury is due to unauthorized care, they may not cover treatment for that condition. In short, to ensure readiness, there is a process active-duty members must follow to receive care from non-network providers. Referrals or prior authorizations are required for most services for TRICARE Prime beneficiaries. Beneficiaries who decide to self-refer and receive care from any civilian provider, without a referral and authorization, may be responsible for costs related to the care they received.