If it's not an emergency, get a referral or pay the price

  • Published
  • By Senior Airman Vernon L. Fowler Jr.
  • 6th Air Mobility Wing public affairs
When it concerns pain and discomfort anything can be viewed as a viable reason to skip the Urgent Care Center and run to the emergency room. However, for those who fall under TRICARE, if the proper protocol is not followed and prior authorization is not given then they could receive a medical bill in the mail.

The Department of Defense Health Affairs policy defines three levels of care:

1) Emergency Care: Beneficiaries seeking emergency care should proceed to the nearest emergency room or call 911 (or other local emergency assistance number) for immediate medical attention, health risks or death.
2) Urgent Care: Defined as a non-emergency illness or injury for which medically necessary treatment is needed. An urgent care condition will not result in further disability or death if not treated immediately; however, treatment should take place within 24 hours of illness.
3) Routine Care: Beneficiaries must be offered an appointment to visit an appropriately trained provider within 7 calendar days and within 30 minutes travel time of the beneficiary's residence.

During regular business hours all patients must contact their PCM team by calling 828-2273 for appropriate guidance prior to pursuing service at an Urgent Care Center (UCC). If an appointment is not available at the military treatment facility, the appointment agents will create a "RED" telephone consult indicating the need for a 2-hour response to the patient. The nurse will determine if the patient will receive a walk-in appointment at the MTF or referred to a UCC. After normal business hours patients can call the Nurse Advice Line (NAL) at 1-800-TRICARE Option #1 or 813-828-2273 Option #2. The NAL is available 24/7 for you to speak with a registered nurse who can: Answer your urgent care question, give advice, or schedule next‐day MTF clinic appointments. If a UCC or Non-Network facility is needed, care must be coordinated through the PCM team or the patient will be billed for services. Per TRICARE Prime Enrollment Form DD Form 2876, all care, other than Emergency Care (life, limb, or eyesight) must be coordinated through their PCM. If not, the beneficiary will be responsible for payment of charges in accordance with Point‐of‐Service (POS) option.  For cost details, visit www.tricare.mil/costs.

Lastly, TRICARE provides easy access via the Humana Military website at www.humanamilitary.com for patients to search network providers closest to them.

If you don't want to be billed directly ensure your medical case meets the emergency requirements or acquire authorization before your visit to the UCC.