Because The Debt Isn't Bad Enough

Specialties Government

Published

This blows my mind.

I seek treatment while on leave over a weekend for a non-emergent condition. I head to the Urgent Care center in a nearby city, obtain fast, cheaper, just as effective treatment, and head out.

A bill comes in the mail from the center. Turns out, TRICARE Prime doesn't pay for most urgent care services. Had I gone to the ER, waited in line for 4 hours, and incurred higher costs for longer, no more effective treatment, TRICARE would have footed the bill. The whole, ridiculously overpriced thing.

But Urgent Care?

Nope.

Heads up to AD folks--suck it up and hit the ER if you need treatment while off duty and unable to get to your station. Either that or call TRICARE directly and obtain a referral to go to the Urgent Care, guaranteeing that they'll pay for it. But I only suggest the latter option if you enjoy elevator music and watching grass grow.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

Just goes to illustrate that logic has nothing to do with anything and this is another reason ERs (both military and civilian) are overcrowded!

Hope you're feeling well. :)

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Hi SoldierNurse-

Did you get the Urgent Care bill taken care of? I used to be Active Duty Air Force and we were able to enter Urgent Care referrals (for Active Duty) retroactively as long as you were at least roughly 30 minutes/30 miles away from an MTF. The Urgent Care also had to bill Tricare, and I was amazed at how many didn't. AF may be different than Army, but maybe call the nurse line or speak to someone in Tricare and see if they can do this? It's worth a shot anyway.

Hope you're feeling better.

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Hey LTinAK,

Thanks for your suggestion! Unfortunately, they just stopped allowing retroactive referrals to be placed in the system. :-( I asked about the same thing, being that I work in healthcare myself and am familiar with the referrals system, but it looks like this one's on me.

:facepalm: This whole thing is unbelievable to me, especially because my intent was to save the govt some money by seeking an appropriate level of care. Well, one way or another, mission accomplished!

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Specializes in Psych ICU, addictions.

Last time I checked, urgent care centers were off the list for Prime family members too...but then again, that last time that I tried was several years ago. I don't know if that's changed.

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The only time we've ever been able to go to urgent care was with a referral from our PCM because of no available appointments or if we called Tricare first. The system is broken. It's crazy that they'd rather I take my kid to the ER for pink eye than to urgent care!

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Specializes in Psych ICU, addictions.
The only time we've ever been able to go to urgent care was with a referral from our PCM because of no available appointments or if we called Tricare first. The system is broken. It's crazy that they'd rather I take my kid to the ER for pink eye than to urgent care!

I once called because the local ER was 5 minutes away and the base ER was 30...and oh yeah, I was bleeding from a knife wound to my hand (looked worse than it actually was). I was told by Tricare that we the civilians can go to the nearest ER without calling ahead. So I've been doing that whenever I had to for myself and the little one, and Tricare has been OK with it.

Besides, the one time I went to the base ER, it was a horrible experience. Apologies if any of you happen to work at my base's ER...but yeah, it really was horrible. Some of most clueless nurses were working; they didn't realize I was also a nurse and knew what was going on...or should have been going on.

I had one great nurse though, a LVN. She was the competent one that night.

Still, I'll have to call and ask about the urgent care center, since I now live within walking distance of one.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

Sometimes our primary care clinic nurses would place referrals for family members to go to off-post urgent care, but nine times out of ten, those patients opted to ignore the referral and come to the ER on post. So primary care has since stopped doing that, and I'm not sure if it's because there were so many unused referrals or if Tricare changed something.

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Why didn't you call the tricare number to find out where you can obtain care? Also I know a few civilians that come to our ER because it is cheaper. If it's not life or death and they provide proof of insurance we treat them. Military ers are cheaper then any civilian urgent care or er. A few will be disappearing in the next 4 years.

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I'm not sure why they don't just pay for it (LunahRN), but it's kinda strange.

DSchulte, I had no clue that I needed to get a referral to seek care at Urgent Care. As in, no idea that the number to call even existed. No idea that a referral was needed to seek an appropriate level of care. I was told to get care and the insurance end would be dealt with later. I wish I had known what they meant by that!

Also, it turns out that if you apply for a referral 5 days after treatment, you can get a retroactive referral to cover the Urgent Care bill. I was on leave for 10 days and none the wiser, however, so I'm still stuck with the bill.

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When you checked into your command and stopped by tricare they give you a card with that information.

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Actually, they didn't. I'm one of those rare birds that took the time to read through the info I was given, and I was given no info regarding a process for care when on leave/out of town and unable to make it to the MTF. Hence, the irritated rant.

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