Urgent care requires pre-authorization

  • Published
  • 509th Medical Group
Tri-Care recently released a new policy concerning the use of urgent care facilities.

Urgent care is provided 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.
Examples of urgent care are a sprain, sore throat or rising temperature that have the potential to develop into an emergency if treatment is delayed longer than 24 hours.

In most cases, urgent care can be provided by your Primary Care Manager by making a same-day appointment.

If you require urgent care while traveling, i.e. on leave, you must coordinate with your PCM and/or your regional contractor before receiving care; most military treatment facilities have a provider on-call 24/7.

Your regional contractor can assist you in finding an urgent care facility in your area.

If you do not coordinate urgent care with your PCM or with your regional contractor prior to receiving care, the care will be covered under the point of service option; POS deductible, $300/individual, $600/family.

POS cost-share, 50% after POS deductible is met. Note: the POS option does not apply to the active duty member.

Active duty must have authorization prior to going to an urgent care facility. Without it, the active duty member could be held responsible for the entire claim.

For any further questions/concerns please contact the Whiteman Referral Management Center at (660) 687-2118.