One call before admission , to TriWest, the regional TRICARE contractor for San Antonio , gives you the three things that matter most before entering treatment: confirmation that the facility is in-network, confirmation that prior authorization has been initiated, and a realistic picture of what you will pay. This page walks through exactly how to do that.
1-888-874-9378 , Monday through Friday, 8am to 5pm local time. For urgent clinical situations, a 24-hour line is available. Have your TRICARE member ID ready before you call.
Step 1: Gather what you need before calling
Before calling TriWest, gather the following. Having everything ready means you can get accurate answers in a single call rather than having to call back.
Your TRICARE member ID and the sponsor’s DOD ID
Your TRICARE member ID is on your military ID card or TRICARE ID card. For family members, you also need the sponsor’s (service member’s) Social Security number or DOD ID number. This is required to pull up your specific plan and benefits.
The facility’s name and NPI number
The NPI (National Provider Identifier) is a unique 10-digit number every healthcare provider has. Call the facility’s admissions or billing department and ask for their NPI. TriWest uses this to confirm network status and initiate authorization for a specific facility.
The level of care you are seeking
Be specific: medical detox, residential (inpatient), partial hospitalization (PHP), intensive outpatient (IOP), or standard outpatient. If you are not sure what level of care is appropriate, you can describe the situation and ask TriWest what levels would typically require authorization.
Your PCM’s name (if enrolled in TRICARE Prime)
TRICARE Prime requires a referral from your Primary Care Manager for civilian specialist and inpatient care. If you are enrolled in Prime, have your PCM’s name ready. TriWest may ask whether a referral has been initiated.
Step 2: Call TriWest and ask these specific questions
When you reach TriWest, ask these questions in order and write down the answers along with the representative’s name and a call reference number.
“Is [facility name] in-network with TriWest for substance use treatment?”
Confirm by facility name and NPI. In-network means the facility has a contract with TriWest and cannot balance bill you for amounts above TRICARE’s allowable charge. Out-of-network means they can. This is the most important question.
“What prior authorization is required before admission for [level of care]?”
For inpatient and residential treatment, prior authorization is always required. For PHP and IOP, it is usually required. Get confirmation and ask how to initiate the authorization , whether you do it, the facility does it, or both.
“What is my cost-sharing for this level of care under my current plan?”
Ask for the specific percentage or co-pay amount. For TRICARE Select inpatient, it is typically the lesser of $535/day or 25% of the allowable charge after your deductible. Confirm whether your annual deductible has already been met for this benefit year.
“How much of my annual out-of-pocket maximum have I already used this year?”
If you are close to the annual cap, costs above the cap are covered at 100% by TRICARE. Knowing where you stand helps you plan. The annual catastrophic cap for TRICARE Select retirees is $3,500 per year for in-network care.
Step 3: Verify with the facility directly
After calling TriWest, call the facility’s admissions team and ask them to confirm their network status independently. A reputable facility that regularly treats TRICARE beneficiaries will confirm their TriWest network status without hesitation and will tell you explicitly that they will not balance bill you.
Ask the facility to put their TRICARE network status confirmation in writing , an email is sufficient. This protects you if there is any dispute after discharge about what you were told before admission.
Also ask the facility who handles prior authorization , whether you are responsible for calling TriWest directly or whether the facility initiates it. Most experienced TRICARE facilities handle prior authorization as part of the admissions process. But confirm this before admission day.
Step 4: Get the authorization number before you arrive
Prior authorization results in an authorization number. This number is the confirmation that TRICARE has approved the level of care for a specific date range at a specific facility. Do not enter a residential or inpatient facility without an authorization number in hand.
The authorization number specifies: the level of care approved, the facility approved for, and the dates covered. If your treatment extends beyond the authorized period, the facility must request a continued stay review before the authorization expires. Ask the facility’s clinical team to alert you when a continued stay review is being submitted so you are aware of the process.
What to do if something is not right after admission
If you receive an Explanation of Benefits after discharge that shows charges you did not expect, do not wait. Call TriWest at 1-888-874-9378 and ask them to explain the EOB line by line. If the claim was processed incorrectly , wrong plan type applied, deductible calculated wrong, authorization not applied , TriWest can reprocess the claim.
If the claim was processed correctly but the bill is higher than you expected because the facility was out-of-network despite your understanding that it was in-network, document the conversations you had during verification and contact TRICARE’s beneficiary assistance coordinator through your installation for guidance.
If a claim is denied, you have 90 days to appeal. See our guide on how to appeal a TRICARE denial.
Common questions
Questions about your coverage?
Call TriWest at 1-888-874-9378 to verify coverage for a specific level of care or facility. Veterans Crisis Line: 988, press 1, available around the clock.
988, press 1 , Veterans Crisis Line