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You receive routine or primary health care from your PCM, and your PCM will refer you to a specialist for necessary specialty care. When making an appointment, contact your PCM’s office directly. There is no need to contact Humana Military to schedule appointments.
Routine (primary) care includes general office visits for the treatment of symptoms, chronic or acute illnesses and diseases, and follow-up care for an ongoing medical condition. Routine care also includes preventive care measures to help keep you healthy. You will receive most of your routine or primary care from your PCM.
The TRICARE Prime point of service (POS) option gives you the freedom to seek and receive nonemergency health care services from any TRICARE-authorized provider without requesting a referral from your PCM for additional costs. However, this will result in higher out-of-pocket costs.
What to Do in Case of an Emergency
TRICARE defines an emergency as a medical, maternity, or psychiatric condition that would lead a “prudent layperson” (someone with average knowledge of health and medicine) to believe that a serious medical condition exists, or the absence of immediate medical attention would result in a threat to life, limb, or eyesight, or when the person has painful symptoms requiring immediate attention to relieve suffering. If you need emergency care, go to the nearest emergency room or call 911. You do not need to call your PCM or Humana Military before receiving emergency medical care. However, in all emergency situations, you must notify your PCM within 24 hours, or the next business day, so that ongoing care can be coordinated, and to ensure you receive proper authorization for care.
Urgent care is for an illness or injury that would not result in further disability or death if not treated immediately, but does require professional attention within 24 hours. You would require urgent care for conditions such as a sprain, sore throat, or rising temperature that have the potential to develop into an emergency if treatment is delayed longer than 24 hours. In most cases, you can receive urgent care from your PCM by making a “same-day” appointment. If you are away from home, contact Humana Military for assistance in obtaining urgent care. If you do not coordinate urgent care with your PCM or regional contractor, the care will be covered under the point of service (POS) option.
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