Is school refusal a covered TRICARE benefit?
TRICARE policy for reimbursement requires that services must be medically necessary for a diagnosed psychological disorder. The disorder must be one referenced in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and must be of a severity not only to cause the patient distress but also to interfere with the patient’s usual activities. Treatment for school refusal, independent of a diagnosed psychological disorder is not a covered TRICARE benefit. TRICARE beneficiaries who have a diagnosable psychological disorder are eligible for eight behavioral health care visits per year without a referral or pre-authorization. Active duty military personnel always need a referral for care outside a military treatment facility.