MALMSTROM AIR FORCE BASE, Mont. --
The National Safety Council urges people to take action to prevent common hazards such as falls, fires, burns and poisoning. The first priority when someone is injured or sick is to seek help. Knowing what type of help is needed can help TRICARE beneficiaries avoid unnecessary expenses.
Urgent care
An urgent condition is an illness or injury that will not cause further disability or death if you're not treated immediately, but requires professional attention to prevent it from developing into a greater threat.
Urgent care centers should be used only if your primary care manager is not available, such as after hours. You must still obtain an authorization for urgent care otherwise you will be billed under TRICARE Prime's point-of-service, or POS, option which includes additional cost-shares and a deductible. Examples of urgent care situations include:
· Minor lacerations;
· Urinary tract infections;
· Earaches;
· Migraine headaches;
· Sprains; and
· Rising fever.
A beneficiary may appeal the payment of a claim under the POS option if they believe the care was an emergency.
Emergency care
TRICARE defines an emergency as a medical condition that someone with an average knowledge of health and medicine believes could threaten life, limb or eyesight without immediate treatment. If you feel the situation requires immediate medical treatment, or there are painful symptoms requiring immediate attention to relieve suffering, the situation is an emergency. Examples of emergency situations include:
· Severe bleeding;
· Chest pains;
· No pulse;
· Inability to breathe;
· Spinal cord or back injury;
· Severe eye injuries; and
· Broken bones.
In an emergency, you should call 9-1-1 or go to the nearest emergency room for treatment. You or someone on your behalf needs to contact your PCM or TriWest within 24 hours if the emergency room visit results in an in-patient admission, so ongoing care can be coordinated.
For more information about TRICARE benefits, visit
www.triwest.com or call 1-888-TRIWEST (874-9378).