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.
You're right. I shouldn't be surprised that the government is wasteful, inefficient and often illogical.
Perhaps I need to put this in perspective. I watched TRICARE pay out thousands and thousands of dollars for chemotherapy, radiation and biotherapy treatments that were often against best practice and almost always unsuccessful. I watched patients refuse to be discharged, sometimes for 4-6 months at a time, incurring thousands of dollars in cost to the TRICARE system. I watched family members dump their elders into our system and refuse to pick them up or sign them over to a nursing home, essentially incurring the same cost. I watch the waste and misuse of the system on a daily basis in my current facility, and no one so much as blinks as the government sneezes away countless dollars on fraud, unnecessary treatments and the like. Assuming you're also a military nurse, I can only assume you've seen something of what I've described above yourself.
So it irks me that I had the presence of mind to seek an appropriate level of care in an attempt to save the government some money (of which they are sorely lacking) and I end up being told nope! We'll pay for this misuse here, we'll pay for this fraud here, but your measly little visit? Sorry. You need to know the system inside and out before you seek care outside our MTFs.
Is it my fault? Partly. While I wasn't dying, I also didn't have the presence of mind to even think about checking out TRICARE's website to see if there were caveats to reimbursement on the outside. I made the costly mistake of assuming the government a rational monster. But the point of this post isn't centered on that--it's the fact that the government won't pick up something as logical as an urgent care visit, and yet it wastes money on stupid crap every single day.
It's clear that you have a working knowledge of TRICARE already. That said, this thread isn't really for you. I posted what I did because I work within the system itself, and I didn't even know about this! I posted so that other professionals that work in the system might see this post and avoid the debacle that I'm now facing, should they also be none the wiser regarding this strange policy.
I applaud your choice to seek an appropriate level of care. I'm sorry you were pretty much monetarily punished for doing the right thing.
DSchulte, for the record, a military ER is NOT less expensive than an urgent care. Not by a long shot. Even if a person has insurance (I am not talking about Tricare), if they are not eligible for care at our MTF, they run the risk of paying the whole bill because their insurance may not cover their visit. I have seen that happen. We warn non-eligible folks and they often proceed anyway, then come back angry about their bill. And those bills are fairly comparable to those I saw as a civilian ER nurse as well.
Lunah, we used to have the exact same issue. We'd strongly encourage them to defer to a different hospital, but man, was it tough to convince folks that they'd thank us for it later.
DSchulte99
72 Posts
The military decides so many things we do. How are you surprised tri care wouldn't do the same?