Accidents happen. Babies get sick. Complications occur. And it seems they never happen at a convenient time. Certainly not always during the typical 9 a.m. to 5 p.m. work day. TRICARE knows this, which is why it's important to know your options for after-hours care. For an Emergency Of course, if you are having an emergency, always call 911 or go to the nearest emergency room. How does TRICARE define "emergency"?
Emergency Care: The care you receive for a medical, maternity or psychiatric condition that would lead a "prudent lay person" (someone with average knowledge of health and medicine) to believe that a serious medical condition exists, or that the absence of immediate medical attention would result in a threat to life, limb or eyesight, or when the person has painful symptoms requiring immediate attention to relieve suffering. This includes situations where a person is in severe pain or is at immediate risk to self or others.
What's important is to know what you must do following your visit. In general, take a look at these steps:
TRICARE Standard/Extra: If you have TRICARE Standard/Extra, you manage your own care. However, you should contact your regional contractor if you are admitted due to a psychiatric emergency. The notification should be made within 24 hours of admission or the next business day. In general, the admission should be reported within 72 hours.
TRICARE Prime: In most cases, if you have TRICARE Prime (including TRICARE Prime Remote, TRICARE Prime Overseas or TRICARE Global Remote Overseas) you need to contact your primary care manager within 24 hours or the next business day after receiving emergency care, so that ongoing care can be coordinated and to ensure you receive proper authorization for care, if necessary.
TRICARE For Life(TFL): In the case of an emergency, TRICARE For Life beneficiaries should go to the closest emergency room or call 911. TFL comes into play when the covered services have been exhausted under Medicare or are otherwise not a Medicare benefit. To remain eligible for TFL, you must have Medicare Part B and follow the Medicare rules.
Since there are so many variables to consider within TRICARE's options, it is a good idea to visit the informative beneficiary Web site and enter your profile to determine your covered services, and what steps you need to take before an emergency arises. For Urgent Care What about urgent care? The TRICARE definition:
Urgent Care: The care you receive for an illness or injury that would not result in further disability or death if not treated immediately, but does require professional attention within 24 hours. Urgent care has the potential to develop into an emergency if treatment is delayed longer than 24 hours.
Again, with the number of variables to consider, we recommend visiting the beneficiary website to learn exactly what you need to do before the need for urgent care arises. In general, the following information applies:
TRICARE Standard/Extra:As mentioned above, when using TRICARE Standard and Extra, you manage your own health care. While you'll never require referrals for any type of care, some services may require prior authorization.
It's also important for you to understand the type of provider you are seeing. You can visit any TRICARE-authorized provider, network or non-network, but the type of provider you see determines your out-of-pocket costs.
TRICARE Prime: You may schedule an appointment with your primary care manager (PCM) for URGENT care, for conditions such as a sprain, sore throat or rising temperature, by making a "same-day" appointment. If you are a registered user on the TRICARE Online Web Portal, you may be able to schedule some appointments at military treatment facilities online. Active duty service members should obtain care in accordance with service guidance.
You should be able to receive an urgent care appointment within 24 hours (one day), even if you are traveling. If you do not coordinate urgent care with your PCM, the care will be covered under the point of service option, resulting in higher out-of-pocket costs.
If you are away from home, contact your regional contractor for assistance in obtaining urgent care: West Region: TriWest, 1-888-874-9378 North Region: Health Net, 1-877-TRICARE South Region: Humana, 1-800-444-544
TRICARE For Life: When using TFL, you manage your own health care. To get your urgent care, simply make an appointment with your Medicare provider. To remain eligible for TFL, you must have Medicare Part B and follow the Medicare rules.Overseas Info There are a number of resources available for beneficiaries living or traveling overseas who encounter an emergency or need urgent care. Check out the TRICARE passport for detailed information on how to proceed with your health care needs while overseas. Also, TRICARE has been working to expand emergency and urgent care options for our overseas active duty service members and their family members. For example, all active duty service members and active duty family members enrolled in TRICARE Prime are now able to access the TRICARE Global Remote Overseas (TGRO) Alarm Center for assistance. Previously, only beneficiaries enrolled in TGRO had access to these services. For more updates, visit:
- Urgent Health Care Options Expanded for Active Duty Overseas
- Overseas Emergency Care for Prime-enrolled Active Duty Family Members
Hopefully you will never need much in the way of after hours care, but take a look now at the steps you need to take within your TRICARE options to alleviate the stress if an emergency ever arises.
The TRICARE Management Activity (TMA) announced November 13th an increase by 5 percent to the reimbursement rate for 24 behavioral health services. The increase is effective immediately and only applies to psychiatric therapeutic procedures from Current Procedural Terminology (CPT) codes 90804-90829. Other reimbursement rates will stay the same until they are reviewed February 2009 by TMA. The eligible behavioral health services are:
- Individual psychotherapy, insight oriented, behavior modifying and/or supportive, using verbal techniques provided in an office or other outpatient facility, an inpatient hospital, partial hospital or residential care facility; and
- Individual psychotherapy, interactive using non-verbal techniques in an office or other outpatient facility, an inpatient hospital, partial hospital or residential care facility.
For additional information on treatment rates by specific location, go to: http://www.tricare.mil/cmac/.
Effective January 1, 2009, TRICARE will reduce the rates for TRICARE Reserve Select (TRS). Monthly premiums for TRS individual coverage will drop 44% from $81.00 to $47.51, and TRS family coverage will drop 29% from $253.00 to $180.17.
TRS is a premium-based health plan for National Guard and Reserve personnel available for purchase by members of the Selected Reserve who are not eligible for or enrolled in Federal Employee Health Benefit plans. TRS provides a health plan option to members of the Selected Reserve and their families when they are not on active duty status. The TRS plan delivers coverage similar to TRICARE Standard and Extra to eligible members who purchase the coverage and pay monthly premiums. TRS also features continuously open enrollment.
A blog to note - MG Elder Granger's Blog