TRICARE and You: After-hours care

Knowing where and how to seek medical care after hours can be a stressful prospect. You may or a family member may be sick or injured and you’re worried about care, but also not incurring a medical bill. Knowing your options in advance will help alleviate some of this stress.

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Written by Cmdr. Paul Fawcett, Health, Safety and Work-Life Service Center

After hours medical care

Knowing where and how to seek medical care after hours can be a stressful prospect. You may or a family member may be sick or injured and you’re worried about care, but also not incurring a medical bill. Knowing your options in advance will help alleviate some of this stress.

The emergency room

Use of the emergency room may or may not be the right answer for your situation. Here are some tips for when and when not to use the ER.

When to use the ER:

If you or a family member have an immediate threat to life, limb or eyesight you should seek immediate emergency medical attention. Depending on your circumstances, that may involve calling 911 and utilizing emergency medical services, or it may involve proceeding on your own to the ER and requesting to be seen.

When not to use the ER:

You generally should not use the ER for non acute situations such as minor illnesses or minor cuts and scrapes that could be treated by basic first aid. You should consult the Nurse Advice Line 1-800-TRICARE (874-2273), Option 1 to answer questions regarding your condition, and determine if you should visit the ER or seek other treatment options if you are unsure. The nurse advice line does have pediatric nurses available for consults regarding younger patients.

Urgent Care

Urgent care centers provide you with another after hours care option. Urgent care centers are normally used for non emergency acute care such as minor illnesses and injuries like strep throat and sprains and strains. Urgent care centers generally permit you to be seen faster than most emergency rooms and provide a better patient experience as you are present with more common illness and injury cases, instead of trauma found in ERs.

Urgent care center visits are also significantly less expensive for the government, and are the preferred treatment source for non-emergency after hours treatment when your PCM is not available.

You should only visit urgent care centers during periods when your primary care manager is not available such as weekends, after hours, and holidays. Many primary care practices have after-hours clinics or nursing services. If your primary care practice has that availability you should go there before seeking treatment at an urgent care center.

Beginning May 23, 2016 and ending May 23, 2019, TRICARE will start an urgent care pilot program that allows two visits per fiscal year to TRICARE-network urgent care centers, without a referral required. This authorization is extended to active duty family members, eligible retirees, enrolled to TRICARE Prime.

Active duty members and activated reservists who are enrolled to TRICARE Prime Remote are also eligible. Dependents and retirees enrolled to TRICARE Standard, and active duty service members enrolled to TRICARE Prime are not eligible for this program.

After you’ve used your two visits per year, if you feel you need additional visits to an urgent care center, you must have a TRICARE referral number or you may be responsible for any incurred costs.

FAQs

Q: Where can I get more information on the urgent care pilot program?

A: The TRICARE website contains information.

Q: How do I know if the urgent care center I want to visit is a networked provider?

A: You can look it up on the TRICARE website.

Q: I’m an active duty member and I’m sick after hours, what should I do?

A: If you have a duty corpsman at your unit you should contact them and receive guidance. If you do not you should call the nurse advice line for guidance. If it’s an emergency you should call 911 or proceed to the ER immediately. In all cases you must inform your command that you required care.

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