TRICARE West (TriWest Healthcare Alliance) Mental Health Coverage Guide
TriWest Healthcare Alliance manages the TRICARE West region, administering benefits for military families in 26 western U.S. states. They manage the civilian provider network, claims processing, and referral management for the western region.
For Military Servicemembers & Families
TRICARE provides comprehensive mental health coverage for active-duty servicemembers, retirees, and their dependents. You do not need a referral for outpatient mental health visits with a TRICARE-authorized provider.
How to Verify Your Mental Health Benefits
Before your first appointment, verify your specific benefits so you know what to expect. Here is a step-by-step process for TRICARE West (TriWest Healthcare Alliance) members:
- Call 1-844-866-9378 and have your member ID card ready.
- Ask to speak with the behavioral health benefits department.
- Ask: "What is my deductible for outpatient mental health services, and how much have I met?"
- Ask: "What is my copay or coinsurance for an in-network therapy session?"
- Ask: "Do I have out-of-network benefits, and what is the reimbursement rate?"
- Ask: "Is prior authorization required for outpatient therapy?"
- Ask: "Is there a session limit per year?"
- Ask: "Are telehealth sessions covered at the same rate as in-person?"
Know Your Rights: Mental Health Parity Act
Federal law requires TRICARE West (TriWest Healthcare Alliance) to cover mental health services at the same level as medical and surgical benefits. If you are denied coverage, ask for the denial in writing and reference the Mental Health Parity and Addiction Equity Act.
Want to keep track of all these details? Use our free benefits verification worksheet to organize your coverage information.
Finding an In-Network Therapist
Search TRICARE West (TriWest Healthcare Alliance)'s provider directory directly: Find a therapist in your area
Tips for Using the TRICARE West (TriWest Healthcare Alliance) Directory
- Filter by "Behavioral Health" or "Mental Health" specialty.
- Check that the provider is accepting new patients before calling.
- Confirm the provider is in-network for your specific plan (not just TRICARE West (TriWest Healthcare Alliance) generally).
- Look for providers who specialize in your specific concern (anxiety, depression, trauma, etc.).
Types of Providers Covered
Telehealth Coverage
TRICARE West (TriWest Healthcare Alliance) covers telehealth therapy sessions, so you can meet with a therapist from home via video or phone.
Couples & Family Therapy
Family therapy covered per TRICARE guidelines.
Understanding Your TRICARE West (TriWest Healthcare Alliance) Coverage
Available Plan Types
Behavioral Health Managed By
TriWest Behavioral Health
Some TRICARE West (TriWest Healthcare Alliance) plans outsource behavioral health management. You may need to call the behavioral health manager directly for authorizations and provider searches.
Prior Authorization
Depends on TRICARE plan type. Prime requires PCM referral; Select does not for in-network.
Substance Use Treatment
TRICARE West (TriWest Healthcare Alliance) covers substance use disorder treatment, including outpatient counseling, intensive outpatient programs, and inpatient rehabilitation.
Common CPT Codes for Therapy
These are the billing codes your therapist will use when filing claims with TRICARE West (TriWest Healthcare Alliance):
| CPT Code | Description |
|---|---|
| 90791 | Psychiatric diagnostic evaluation |
| 90834 | Individual therapy (45 minutes) |
| 90837 | Individual therapy (60 minutes) |
| 90847 | Family / couples therapy (with patient present) |
| 90846 | Family therapy (without patient present) |
| 90853 | Group therapy |
How to Get Reimbursed (Out-of-Network)
If you are seeing a therapist who is not in TRICARE West (TriWest Healthcare Alliance)'s network, you may still be able to get reimbursed. Here is how:
- Pay your therapist directly at the time of your session.
- Request a superbill from your therapist after each session. This is a detailed receipt with the information TRICARE West (TriWest Healthcare Alliance) needs to process your claim.
- Submit your claim to TRICARE West (TriWest Healthcare Alliance) using one of these methods:
- Online: Submit through the member portal
- Mobile App: Submit via the TRICARE West (TriWest Healthcare Alliance) app
- Fax: 1-844-235-4269
- Mail: TriWest Healthcare Alliance, P.O. Box 6040, Phoenix, AZ 85005-6040
- Wait for processing. Most claims are processed within 30 days. You will receive an Explanation of Benefits (EOB) showing what was covered.
TRICARE West (TriWest Healthcare Alliance) Claims Note
TriWest manages the TRICARE West region provider network and claims processing.
What Your Superbill Should Include
- Therapist's name, credentials, NPI number, and tax ID
- Date of service
- CPT code (e.g., 90834 or 90837)
- ICD-10 diagnosis code
- Amount charged
- Your name and date of birth
TRICARE West (TriWest Healthcare Alliance) tip: Submit claims through the TriWest portal. Referral requirements depend on your TRICARE plan type (Prime vs. Select).
Save Money on Therapy with TRICARE West (TriWest Healthcare Alliance)
Use Your HSA or FSA
Therapy is an eligible expense for Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs). You can use these pre-tax dollars to pay for copays, coinsurance, and out-of-network therapy costs, effectively saving 20-35% on your therapy expenses.
Ask About Sliding Scale Fees
Many therapists offer reduced rates based on your income. If you have a high deductible TRICARE West (TriWest Healthcare Alliance)plan or high out-of-pocket costs, ask your therapist about sliding scale options. Some therapists will also offer "single-case agreements" with TRICARE West (TriWest Healthcare Alliance) at a negotiated rate.