If you or your child gets sick or injured, your first instinct is to go to the emergency room (ER) right away or call 911. These are good instincts in an emergency, but many people use the ER when it is not an actual emergency. This contributes to long ER wait times, high costs, and unnecessary medical care. Sometimes, using an urgent care clinic may be your best choice, and can help responsibly preserve the TRICARE benefit for future generations of military families.
It can be difficult to know whether an illness or injury is really an emergency, but the judgment is yours to make. If the condition is obviously life threatening, or causing severe pain and distress, then the need for an emergency room is clear. TRICARE views an emergency as a medical, maternity or psychiatric condition you believe could threaten your life, limb or sight without immediate medical attention. Other emergencies include severe, painful symptoms requiring immediate attention, or when a person may be an immediate risk to themself or others.
If you or a family member experience any of the following symptoms, go to the ER immediately:
- Chest pain or pressure
- Uncontrolled bleeding
- Sudden or severe pain
- Coughing or vomiting blood
- Difficulty breathing or shortness of breath
- Sudden dizziness, weakness, or changes in vision
- Severe or persistent vomiting or diarrhea
- Changes in mental status, such as confusion
You do not need authorization for emergency care before receiving treatment. However, if you’re enrolled in a TRICARE Prime plan you must contact your primary care manager or regional health care contractor within 24 hours or the next business day after you receive emergency care.
Urgent care is when an illness or injury is serious enough to seek health care right away, but not so severe as to require emergency room care. Some examples include earache, toothache, joint sprain, muscle pull or urinary tract infection. You can get urgent care from your primary care manager (PCM), or from an urgent care center if your PCM is inaccessible. Urgent care can be quicker, with a lower cost and better results, compared to a crowded ER that may require unnecessary tests or hospital stays.
Many urgent care centers are open after normal business hours and on the weekend, so you can go at a time that fits with your schedule, or when a health problem warrants. If you have TRICARE Prime, you need to get prior authorization from your PCM or your regional contractor to avoid additional costs for visiting an urgent care center. If you are traveling, you need to contact your home region for authorization. You can find contact information for your regional contactor at www.tricare.mil/contacts.
According to the Urgent Care Association of America, 57 percent of visits to an urgent care facility have a wait time of 15 minutes or less. By comparison, the Centers for Disease Control and Prevention report only 22 percent of visits to an emergency room have wait times of 15 minutes or less.
Getting urgent care instead of visiting the ER can also save money. ERs are required to run expensive diagnostic tests that may not be necessary if your condition is less serious. Being judicious with your healthcare spending can make your household budget go further, and cost efficient urgent care will help protect your TRICARE benefits in these uncertain financial times.
It’s a good idea to be aware of nearby urgent care facilities in the TRICARE network, just as you would with the closest emergency room. To find an urgent care facility near you in the TRICARE network, visit www.tricare.mil/mybenefit/home/Medical/FindingAProvider and select the search tool for your regional contractor.