Does TRICARE Cover Treatment for Mental Health and Substance Use Disorders?

As a TRICARE member, mental health and substance use disorder services are available for you and your family during times of stress, depression, grief, anxiety, mental health crisis, or the misuse or abuse of alcohol or drugs.

This post offers basic information aimed at helping you get the help you need. You can visit http://www.tricare.mil/mentalhealth for more detailed and specific information.

Outpatient Treatment and Services

In most cases, prior authorization is not required for any outpatient mental health or substance use disorder visit.

NOTE: TRICARE stipulates that active-duty service members, or ADSMs, should always seek nonemergency mental health care at military hospitals or clinics when available.

When necessary services are not available, ADSMs can get referrals and/or prior authorizations from their primary care manager to receive civilian care from a TRICARE-authorized provider.

Covered Services Include:

• Individual psychotherapy: Therapy may be used when medically or psychologically necessary for adults and children to ease emotional issues that impact the ability to function, to reverse or change troubling behavior and to assist with coping in times of personal crisis.
• Family or conjoint psychotherapy: As with individual psychotherapy above, therapy designed to treat the entire family is also covered.
• Group psychotherapy: Therapy in which multiple patients are treated together as a group is also covered.
• Collateral visits: Collateral visits are not therapy sessions, but visits intended to gather information, implement treatment goals and assess progress. They are also included in coverage.
• Psychoanalysis: Psychoanalysis is long-term mental health therapy which explores unconscious thoughts to gain insights into behaviors and symptoms. Treatment must be given by approved providers who are specifically trained in psychoanalysis and always requires prior authorization.
• Psychological Testing and Assessment: Testing and assessment are covered when medically or psychologically necessary and are provided in conjunction with otherwise covered psychotherapy.
• Medication Assisted Treatment: Medication assisted treatment (MAT) combines medication and mental health therapies to treat substance use disorders. MAT is covered when administered by a TRICARE-authorized provider.
• Intensive Outpatient Treatment: Intensive outpatient treatment is covered when a mental health provider believes it is necessary to provide an organized day or evening program that includes assessment, treatment, case management and rehabilitation for individuals who don’t require 24-hour care for mental health and/or substance use disorder.
• Partial Hospitalization Treatment: Partial hospitalization treatment is covered when a mental health provider believes it is necessary to stabilize a critical mental health disorder that doesn’t require continued 24-hour care in an inpatient psychiatric setting, or to transition an individual from an inpatient program to an outpatient program.

Telemedicine Treatment and Services

In some cases, mental health treatment and services may be administered via telemedicine visits, which utilize secure video conferencing to connect patients with providers.

Telemedicine services are covered through TRICARE, having the same requirements for referrals and prior authorizations as traditional mental health care services.

Inpatient Treatment and Services

Inpatient treatment and services are covered by TRICARE, although availability, care access and referral and prior authorization requirements for inpatient services vary by beneficiary type, location and TRICARE program option.

Generally speaking, referral and prior authorization is required for all nonemergency inpatient mental health care services.

NOTE: Psychiatric emergencies do not require prior authorization, but authorization is required for continued stay.

Covered Services Include:

• Acute Inpatient Psychiatric Care: A patient may be referred to acute inpatient psychiatric care if their health care provider believes the individual has a mental health disorder that threatens their physical well-being or the well-being of others, to the extent that medical and psychiatric care is needed on a 24-hour-a-day basis for safety and stabilization.
• Psychiatric Residential Treatment Center Care: A psychiatric residential treatment center provides extended care for patients who have mental health disorders requiring treatment in a therapeutic environment 24/7. Psychiatric residential treatment always requires a referral and prior authorization.
• Inpatient and Residential Substance Use Disorder Rehabilitation: TRICARE reimburses the cost of care only if you visit a TRICARE-authorized institutional provider.
• Inpatient Management of Withdrawal Symptoms (Detoxification): TRICARE covers emergency and inpatient hospital services for the treatment of the acute phases of substance use withdrawal (detoxification) when the patient’s disorder requires the personnel and facilities of a hospital or substance disorder rehabilitation facility. SUDRF. You will need prior authorization for non-emergency services.

Let Us Help!

We, at Honey Lake Clinic, understand that finances weigh heavily on your decision to pursue mental health and/or substance use disorder treatment.

We also recognize that navigating your way through insurance coverage can be confusing and overwhelming.

As a TRICARE-authorized provider, members of Honey Lake Clinic’s admission staff are highly trained and experienced at working with TRICARE to get you the help you need.

A member of our staff will be happy to run a Verifications of Benefits (VOB) as a courtesy—at no cost to you—to clarify exactly what your specific policy will cover, and to help understand your benefits and what to expect from the process