Urgent Care procedures for Whiteman
By , Information courtesy of 509th Medical Group
/ Published August 29, 2007
WHITEMAN AIR FORCE BASE, Mo. --
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, beneficiaries must still 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.
To obtain an urgent care authorization:
· In area, 7:30 a.m.-4 p.m. Monday-Friday - Contact the primary care manager at 563-9100.
· In area, 4 p.m. -7:30 a.m. Monday-Friday and weekends and holidays (24 hours) - Contact the PCM on-call at 1-800-334-2958.
· Out of area (all days and hours) - Contact the PCM on-call at 1-888-993-4945.
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 it was billed in error.
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 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, beneficiaries should call 911 or go to (or be taken to) the nearest emergency room for treatment. The beneficiary or a family member must contact the primary care manager or TriWest within 24 hours if the emergency room visit results in an inpatient admission, so ongoing care can be coordinated.
For more information about TRICARE benefits, visit www.triwest.com or call 1-888-TRIWEST (874-9378).