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Use of urgent care centers and emergency rooms

  • Published
  • By Lt. Col. Sharon J. Gober
  • 6th Medical Operations Squadron commander
How well do you know the benefits available to you through your Tricare plan? Some insurance directives are specific to your local military treatment facility. Through past experiences, our population has grown accustomed to having all expenses related to medical care, prescriptions and tests paid, not giving too much thought to seeking urgent care center or emergency room services. This is even true for non-emergent problems which could better be handled by calling your primary care manager. In fact, the majority of these non-emergent visits are minor issues that can be managed by home care to include using over-the-counter medications. In order to stay within budget constraints and optimize the care of our patient population, policies and guidelines have been put in place that your PCM and Tricare must follow. It is in your best interest to become familiar with those policies as well as your overall benefit program.

What prompts someone to go directly to a UCC or ER instead of calling their PCM team to schedule an appointment or being triaged first? Reasons for this choice may include: convenience of being seen when and where you want; confusion regarding the severity of your illness; or the lack of clarity about which over-the-counter medication may be most effective to purchase. However, there are several opportunities for you to get the answers you need. During duty hours you may contact your local MTF to speak to your PCM team nurse; after hours you may call 813-827-2273 to review your acute symptoms questions. They can assist in assessing if you should be seen, how soon, by whom and if there are any recommendations regarding managing your symptoms via home care. After all, majority of illnesses are self-limited, short term and may be best managed with simple measures to provide quick relief of bothersome symptoms. In addition to your PCM team, you can access the "symptom checker" at Furthering your home health options in the next couple months, the Air Force will launch a Nurse Advice Line to assist patients with advice and triage regarding your acute care needs.

Once your PCM team helps you determine that urgent care is needed, ensure that your UCC location is a Tricare network facility; non-authorized facility visits may not be paid for. Authorized facility listings may be found at Also be aware that some UCCs will order tests such as MRIs or tell you to return for a follow up visit - neither of which would be covered by Tricare Prime. All follow-up visits should be coordinated with your PCM team and most specialty tests will require a referral from your PCM. An ER will always be considered network. The caveat is that you should only present to the ER if there is a threat to your life, a limb or your eyesight or if directed to go by your PCM team. Misuse of ERs is a huge burden on the system. Ever wonder why you may wait hours to be seen when presenting to the ER? It is because the staff is caring for non-emergent problems and all non-emergent care will stop when the ER receives a true emergency. While UCCs usually only incur a small cost, an ER visit may run up costs into the thousands of dollars. Please join us in being guardians of our great medical benefit.

Insurance coverage is confusing and knowing what you can or should do to seek healthcare without incurring cost to you is important to understand. By proactively following local guidelines you can avoid unnecessary costs, wait times and exposures to dangerous illnesses which lurk in ER settings. Look up your signs and symptoms; try to take care of your minor illnesses such as colds or gastrointestinal upsets at home. Most importantly, be sure to assess if life, limb and eyesight might be affected. Remember, if you are not sure - ask the question! Your PCM team is here for you. Call 813-828-CARE (2273) for an appointment or speak to a nurse. Your MacDill/Brandon health care teams look forward to caring for you in the future!