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New Tricare Nurse Advice Line Could Make Urgent Care Easier

A new nurse advice line staffed by real humans available full time -- including nights and weekends -- to nearly all Tricare users could make getting seen at an off-base urgent care slightly easier.

The advice line, which you can reach by calling 1-800-874-2273 and hitting option 1,  is aimed at keeping family members who don't actually need to be seen out of offices, and make sure those who do need to be seen head to the right place at the right time.

Edit: Tricare officials say that while you may have used something similar to this service in the past overseas or run by your local Tricare contractor, this is the first time one has ever been offered stateside Tricare wide to almost all beneficiaries with the ability to help you make appointments.

Once the line's roll-out is complete operators will be able to help those seen at military treatment facilities get a same-day appointment or, if one is not available (or the office is closed) help them get an urgent care referral.

Since most non-Prime users don't need a referral to hit up an Urgent Care facility, the line will be most useful to them for general advice.

For those of us on Prime here's how the Urgent Care process works:

If you are enrolled in a military treatment facility:  If the nurse advice line tells you to go to urgent care because no same day appointments are available or because the MTF is closed, they will submit your referral to the MTF, which will then process it and send it to the urgent care facility. If the referral office is closed, they will process it retroactively.

If you are on Prime and seen by an off-base civilian provider:  If the nurse line tells you to seek urgent care, go ahead and do so -- but you'll need to follow-up personally with your doctor's office to have them submit a retroactive referral.

The nurse line will be able to tell you which urgent care in your area is considered an "in-network" location. Make sure you go there -- and not to one outside the Tricare network, or they won't cover it.

Hold the phone. "Retroactive approval" sounds dangerous. I agree. In fact, I've had the local in-network urgent care turn me down because we didnt have a referral number already in their hot little hands.

But Tricare officials assured me that retroactive approvals are actually the norm. And, thanks to the roll-out of the advice line, commonly used urgent care locations around MTFs should be notified that they might seen an up-tick in patients.

"Over half of all referrals are given retroactively, which means patients have sought and received care from an urgent care facility without prior approval from their primary care manager," said Tricare spokesman Kevin Dwyer. " MTF enrollees who are visiting an urgent care facility requiring a referral reference number should state that they've called the Tricare Nurse Advice Line (NAL) and have permission to seek urgent care. Patients and urgent care facilities can also call the NAL at 1-800-874-2273 Option 1; the clerk can look up the patient's NAL encounter to verify the patient was advised to seek urgent care."

Here are some more helpful things to know about the new advice line:

They have pediatric specialists. And they'll do a follow-up call for you. If you're calling about something for your child, you'll be forwarded to a nurse specifically trained in pediatric issues, Tricare officials said. And they will offer to follow-up with you later in the day just in case.

They are available all the time. The line promises a real human 24 hours a day, seven days a week. Helpful!

Some Tricare users aren't covered -- but not many. If you're in the US Family Health Plan you can't use the advice line. Everyone else is in.

If  you are stationed overseas but traveling stateside, you can still use it. If you happen to be back in the states and have a medical need, go ahead and call the advice line. However, if care is needed, you're going to have to call your TOP Regional Call Center to coordinate.

They'll let your MTF provider know you got help from them. If you're enrolled at an MTF the nurse line will notify your provider that you received advice -- and what the advice was.

 

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