Understanding Urgent Care
Do you know when to use an urgent care clinic instead of an emergency room? Health Net Federal Services LLC, the managed care contractor for the TRICARE North Region, offers the following Q&As to help you take charge of your health by selecting the appropriate health care facility when you need care.
Q: What is urgent care?
A: Urgent care is the care needed to prevent an injury or illness from becoming a serious health risk.
Q: What health conditions are considered urgent?
A: Examples of urgent care conditions include a sprained ankle, a persistent cold and a sore throat.
Q: When should I use an urgent care clinic?
A: It is appropriate to use an urgent care clinic when your primary care manager (PCM) is not available, such as after hours or on weekends.
Q: Is urgent care the same as a medical emergency?
A: No, urgent care is not the same as a medical emergency. A medical emergency threatens life, limb or eyesight. If you or someone you know is experiencing a medical emergency, call 911 or go to the nearest emergency room.
Q: What are the benefits of an urgent care clinic?
A: Urgent care clinics are conveniently located and have shorter wait times than emergency rooms.
Q: Do I need a referral before I go to an urgent care clinic?
A: TRICARE Prime, TRICARE Prime Remote and TRICARE Young Adult Prime members need a referral before going to an urgent care clinic.
To obtain a referral to an urgent care clinic, call your Primary Care Manager or Military Treatment Facility. If you are unable to reach your Primary Care Manager or Military Treatment Facility, call Health Net Federal Services at 877-TRICARE (877-874-2273).
Q: Where can I find an urgent care clinic?
A: Use the Network Provider Directory to locate an urgent care clinic near you. Type in your ZIP code, and Under Specialty select Urgent Care Center or Convenient Care Clinic. You may also call 877-TRICARE (877-874-2273) for assistance.
Q: What happens if I go to an urgent care clinic without a referral?
A: When TRICARE Prime, TRICARE Prime Remote and TRICARE Young Adult Prime members use an urgent care clinic without a referral, they are choosing the Point of Service option, which has higher out-of-pocket costs. The Point of Service option does not apply to active duty service members, so they may be responsible for the entire cost of care.
For more information about urgent care, visit http://www.hnfs.com/ click on I’m a Beneficiary > Authorizations > Urgent Care – Phone First under Popular Topics.
Courtesy of Health Net Federal Services.