|
|
Routine, Emergency and Urgent Care
|
Emergency Care
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. It is important that you know the emergency telephone numbers in your area. Take a minute to look these numbers up and write them here or on the inside front cover of this book.
| Emergency Assistance: |
|
| Ambulance: |
|
| Poison Control: |
1-800-222-1222 |
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
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 Humana Military, the care will be covered under the point of service (POS) option, resulting in higher out-of-pocket costs. See the TRICARE: Summary of Beneficiary Costs flyer to learn about POS fees.
Routine (Primary) Care
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.
You do not need a referral to visit your PCM. If your PCM is unable to provide the care needed, he or she will refer you to another provider. If you receive any routine care without a referral from your PCM, you will be utilizing the POS option, resulting in higher out-of-pocket costs. See the TRICARE: Summary of Beneficiary Costs flyer to learn about POS fees.
Services That Do Not Require Referrals
Some services may be obtained without a PCM referral. These include clinical preventive services and the first eight outpatient behavioral health care visits per fiscal year (October 1-September 30). When seeking clinical preventive services or behavioral health care, you must use a network provider. If you seek care from a non-network provider without a referral from your PCM, you will be utilizing the POS option, resulting in higher out-of-pocket costs. See the TRICARE: Summary of Beneficiary Costs flyer to learn about POS fees.
For more information about these services, see the Covered Benefits, Limitations, and Exclusions section. Remember, you will never need a referral for emergency care. Note: Active duty service members require a referral for any clinical preventive services, behavioral health care, or specialty care.
Back to Top
|
