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Tricare and ER visits

How do they work? Just call after?
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Re: Tricare and ER visits

  • I've been told to call before but I think you have like 24 hrs to call them. When my sister went she called the nurse line before and told them she was going. It was better that way because she was admitted for three days. I think it's something about your PCM writing a referral or something.
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  • I've never called after an ER visit. Doesn't mean you shouldn't I guess just that I haven't. I've also never called after Urgent Care. Once upon a time, they wanted you to go down to the tricare office and present the release paperwork for them to copy and have you fill out something but I think they changed that.

    I'm so helpful, aren't I? lol sorry



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  • What I have heard (but never tested) is that if you need emergency care, get it.

     

    Once you have received care, and if this was done somewhere other than a military treatment facility (ie: base hospital, not neccessarily _your_ base), you should call tricare to report the situation, and they may have some paperwork, or need some information from you at that time.

     

    As mentioned, though, I've never had to test this.  The closest I came was going to a walk-in clinic while in another country.  I tried reporting it to Tricare, but the concept of a walk-in clinic seemed difficult for the rep I spoke to to understand (I tried reporting prior to going to the clinic because it wasn't emergency care, just a situation that needed to be remedied before I flew home, and couldn't say exactly which of the 8 doctors associated with that clinic I was going to see, so Tricare wouldn't take down any information...).  I got home, and Tricare wanted multiple pages of information filled out in quintuplet, or something like that, as well as a bunch of documents from the clinic (again, from the clinic in another country), and I decided it wasn't worth my time to track it all down for the $120 I spent on appointment, lab test and prescription...

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  • I had to go to the ER when I was in Wyoming in May.  I called Tricare first because I wanted to go Insta Care (like urgent care), but I had to have a referral from my PCM (who I had never been too) to go there. When I told I had never been to my PCM the lady said, "just go to the ER we cover all ER visits."  I never called back or anything, and I asked her if I had to do anything else.  I haven't received any bills, just paper work saying what Tricare covered.

    But I would call just to be safe.

  • Theoretically, you're supposed to get pre-authorization.  But ER you can call after.  Actually I never called for my ER visit, and it was covered.
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  • Technically, you are supposed to call within 24 hours after going to an ER. You can go to any ER, but they want you to notify them. I've called for one visit, and not called for another. There was no difference in coverage with the one I forgot to call on. 
  • I've also never called before or after. It's always just been taken care of. Now, I don't know if that's because here I can't use the base clinics and whatnot, but I've never called and alerted TC. I do have to call my doctor after a visit to a walk-in clinic to get a referral, but that's the clinic's policy and not TC's.
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  • I've never called afterwards. 

    I hope you're okay.  

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  • imageKiller Cupcake:

    They cover all ER visits, but urgent care is cost shared. 

    I always call after just to be safe, but the ER visits are covered either way.  

    I only had to pay a portion of urgent care when we were still standard. Since we've been on prime, they've paid the full bill.

    But that could be because I only go the urgent care when the on post clinic is closed?



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  • That might be it. The urgent case clinic I use is affiliated with the local hospital system which takes tricare easily.


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  • I've been to urgent care twice and have never been charged.  The first time it was the base clinic who told me to go b/c they didn't have appointments for a couple weeks, and I was really sick right then.  I think I called tricare ahead of time once, and it was sort of an emergency walkin in the other time, and I don't remember if I ever called.
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