|Covered by TRICARE?||Limits|
TRICARE covers emergency care to include professional and institutional charges and services and supplies that are ordered or administered in an emergency department.
Call 911 or Go to the Emergency Room
Make sure you go to an emergency roomTRICARE defines an emergency department as an organized, hospital-based facility available 24 hours a day providing emergency services to patients who need immediate medical attention.. Urgent care clinics offer quick walk-in services without an appointment, but these facilities are not considered to be "emergency rooms." If you go to an urgent care clinic, make sure you follow your plan's rules for getting urgent care.
Enrolled in TRICARE Prime?
If you're enrolled in a Prime planIncludes TRICARE Prime, TRICARE Prime Remote, TRICARE Prime Overseas, TRICARE Prime Remote Overseas and TRICARE Young Adult-Prime Option, contact your primary care manager within 24 hours or the next business day after you receive emergency care.
What is an Emergency?
Examples of emergencies include:
- No pulse
- Severe bleeding
- Spinal cord or back injury
- Chest pain
- Severe eye injury
- Broken bone
- Inability to breathe
See the chart below for more information.
The sudden and unexpected onset of a medical condition or the acute exacerbation of a chronic condition that is:
- Threatening to life, limb or eyesight
- Requires immediate medical treatment
- Manifests painful symptoms requiring immediate respone to alleviate suffering
||A sudden unexpected medical complication which puts the mother or baby at risk
When the patient is at immediate risk of serious harm to self or others as a result of mental disorder and requires immediate continuous skilled observation at the acute level of care.*
- Prior authorization is not required for emergency department care.
- Admissions resulting from a psychiatric emergency should be reported to the regional contractor within 24 hours of admission or the next business day after admission but must be reported within 72 hours of the admission.
*Based on a psychiatric evaluation performed by a physician or other qualified mental health care professional with hospital admission authority.
This list of covered services is not all inclusive. TRICARE covers services that are medically necessary and considered proven. There are special rules or limits on certain services, and some services are excluded.