Emergency and urgent care: it pays to know the difference
By Jenna Holtz, TRIWEST Healthcare Alliance
/ Published July 05, 2007
MCONNELL AIR FORCE BASE, Kan. -- The Safety Council is urging all of us to take measures to prevent common hazards such as falls, fires, burns, and poisoning. The first priority people do when they or their loved ones are injured or sick should be seeking help. Knowing what type of help is needed can help TRICARE beneficiaries avoid unnecessary expenses.
What is Urgent Care?
An urgent condition is an illness or injury that won't cause further disability or death if not treated immediately, but requires professional attention to prevent it from developing into a greater threat.
Urgent care centers should be used only if the primary care manager is not available, such as after hours. Regardless, people must obtain an authorization for urgent care otherwise they will be billed under TRICARE Prime's point-of-service option, which includes additional cost-shares and a deductible. Examples of urgent care situations include, but are not limited to the following:
· Minor lacerations.
· Urinary tract infections.
· Migraine headaches.
· Rising fever.
A beneficiary may appeal the payment of a claim under the POS option if they believe the care was an emergency.
How is Emergency Care Different?
TRICARE defines an emergency as a medical condition that a "prudent layperson" - someone with an average knowledge of health and medicine, believes could threaten life, limb or eyesight without immediate treatment. If people feel the situation requires immediate medical treatment, or there are painful symptoms requiring immediate attention to relieve suffering, the situation is an emergency. Examples of emergency situations include but are not limited to the following:
· Severe bleeding.
· Chest pains.
· No pulse.
· Inability to breathe.
· Spinal cord or back injury.
· Severe eye injuries.
· Broken bones.
In an emergency, call 911 or go to the nearest emergency room for treatment. The patient or someone on their behalf should contact their primary care manager or TriWest within 24 hours if the emergency room visit results in an inpatient admission.
For more information about TRICARE benefits, please visit www.triwest.com or call 1-888-TRIWEST (874-9378).