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TRICARE patients should follow procedure for non-PCM care

  • Published
  • By 375th Medical Group
SCOTTT AIR FORCE BASE, Ill. --  What are you going to do if you or a family member needs medical care after your primary care doctor's office is closed? If you believe it is an emergency, the simple answer is to call 911 or go to the nearest emergency room. In an emergency situation, there are no prior authorization requirements--get the life, limb, or eyesight saving care as soon as possible.

But if it's not an emergency, the following information 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 if that same condition were treated in the emergency department.

Example: Treatment for sore throat or bronchitis--cost to TRICARE if seen in emergency room: about $400; if seen in urgent care center: 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. For those beneficiaries assigned a PCM at Scott Air Force Base, you are expected to contact your PCM for guidance by calling (618) 256-WELL/9355 prior to obtaining care. If your PCM authorizes urgent care, he or she will arrange for an authorization to be provided during normal hours.

If the PCM can't be reached, the Prime member can call 877-TRICARE and state that he/she was unable to contact his/her 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 in becoming established with your PCM it is a good idea to discuss after hours care procedures with your provid