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How to seek medical care after normal hours

  • Published
  • 375th Medical Group
What do you do if you or a family member needs medical care after your primary care doctor's office is closed? If you believe the situation is an emergency, the simple answer is to call 911 or go to the nearest emergency room.

But if it's not an emergency, the information below could save you time and in many cases some money. For non-emergency situations using an alternative to the emergency room such as an urgent care center could result in less waiting time, more convenient locations, and receiving the needed care at considerably less cost than treatment in the emergency department.

For example, the cost to TRICARE for treatment of a sore throat or bronchitis in an emergency room is about $400. Treatment at an urgent care center costs about $90.

For those enrolled in TRICARE Prime, there are required procedures if you will be obtaining non-emergency care from other than your primary care manager, or someone covering for that provider. In an emergency situation, there are no prior authorization requirements--get the life or limb saving care as soon as possible. For other than emergency care, one is expected to contact their PCM for guidance. If the PCM authorizes urgent care, he or she will arrange for an authorization to be provided during normal hours.

If the PCM cannot be reached, the Prime member can call 1-877-TRICARE and state that they were unable to contact their PCM. The health care locator can provide a one-time authorization and also can provide the name and location of the nearest network urgent care center (or if necessary, out of network--especially for travelling beneficiaries). As part of the process of becoming established with one's PCM it is a good idea to discuss after hours care procedures with the provider's office.