Urgent care explained Published Aug. 29, 2007 By Jenna Holtv TriWest Healthcare Alliance GRAND FORKS AIR FORCE BASE, N.D. -- What is urgent care? An urgent condition is an illness or injury that won't cause further disability or death if not treated immediately, but requires professional attention to prevent it from developing into a greater threat. Urgent care centers should be used only if the primary care manager is not available, such as after hours. Regardless, beneficiaries must still obtain an authorization for urgent care; otherwise they will be billed under TRICARE Prime's point-of-service option, which includes additional cost-shares and a deductible. To obtain an urgent care authorization: · In area, 7 a.m. to 4:30 p.m. Monday through Friday: Call the primary care manager at 701-747-5601 or 1-866-747-5601. · In area, 4:30 p.m. to 7 a.m. Monday through Friday and weekends and holidays (24 hours): Contact the PCM on-call at 701-747-5601 or 1-866-747-5601. · Out of area, 7 a.m. to 4:30 p.m. Monday through Friday: Call the PCM at 701-747-5601 or 1-866-747-5601. If approved to seek urgent care, beneficiary may contact TriWest at 1-888-TRIWEST (874-9378) for assistance in locating an urgent care provider. · Out of area, 4:30 p.m. to 7 a.m. Monday through Friday and weekends and holidays (24 hours): Contact the PCM on-call at 701-747-5601 or 1-866-747-5601. If approved to seek urgent care, beneficiary may contact TriWest at 1-888-TRIWEST (874-9378) for assistance in locating an urgent care provider. Examples of urgent care situations include, but are not limited to, the following: · Minor lacerations · Urinary tract infections · Earaches · Migraine headaches · Sprains · Rising fever A beneficiary may appeal the payment of a claim under the POS option if they believe it was billed in error. How is emergency care different from urgent care? TRICARE defines an emergency as a medical condition that a person believes could threaten life, limb or eyesight without immediate treatment. If 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, but are not limited to, the following: · Severe bleeding · Chest pains · No pulse · Inability to breathe · Spinal cord or back injury · Severe eye injuries · Broken bones In an emergency, beneficiaries should call 911 or go to (or be taken to) the nearest emergency room for treatment. The beneficiary or a family member must contact the primary care manager or TriWest within 24 hours if the emergency room visit results in an inpatient admission, so ongoing care can be coordinated. For more information about TRICARE benefits, visit www.triwest.com or call 1-888-TRIWEST (874-9378).