Emergency, urgent care: it pays to know the difference Published June 28, 2007 By Jenna Holtz TriWest Healthcare Alliance -- June is National Home Safety Month and the National Safety Council is urging everyone to take measures to prevent common hazards such as falls, fires, burns and poisoning. Of course, the first priority is to seek help when you or a loved one is injured or sick. Knowing what type of help is needed can help TRICARE beneficiaries avoid unnecessary expenses. 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 your primary care manager is not available, such as after hours. Regardless, you must still obtain an authorization for urgent care otherwise you will be billed under TRICARE Prime's point-of-service option, which includes additional cost-shares and a deductible. 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 point-of-service option if they believe the care was an emergency. How is emergency care different? TRICARE defines an emergency as a medical condition that a "prudent layperson" - someone with an average knowledge of health and medicine - believes could threaten life, limb or eyesight without immediate treatment. If you feel 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, you should call 911 or go to (or be taken to) the nearest emergency room for treatment. You or someone on your behalf need to contact your primary care manager or TriWest within 24 hours if the emergency room visit results in an impatient admission, so ongoing care can be coordinated. For more information about TRICARE benefits, please visit www.triwest.com or call 1-888-TRIWEST (874-9378).