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TRICARE issues new policy

By TRICARE South and Naval Hospital Jacksonville Public Affairs | | November 24, 2010

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TRICARE Prime enrollees are reminded to access all non-emergent care through their primary care managers and to only go to the emergency room for true emergencies.

In rare circumstances and before accessing care from any other provider, enrollees should get a referral from their PCMs and an authorization from the managed care support contractor to avoid being billed under the expensive point-of-service option.

As of Dec. 1, no retroactive referrals for non-emergent care will be provided by the Naval Hospital or its branch health clinics.

In most cases, TRICARE Prime beneficiaries should first call their PCMs to schedule an appointment, either as a NHBC Albany clinic visit or with a TRICARE network provider. If beneficiaries enrolled with the NHBC Albany are unable to reach their PCMs they should call NH Jax Central Appointments at (800) 529-4677. Calls to that line roll over to the hospital’s Nurse Advice Line after hours, where callers can get assistance on accessing appropriate care.

Emergency room visits are the most expensive way to receive health care. While many TRICARE beneficiaries pay no out-of-pocket expenses themselves, this level of care is hardly free. It is passed on to all enrollees. The bill is a single emergency room visit sometimes being 10 times more expensive than an urgent care visit, according to a press release from NH Jax.

“The point-of-service option allows beneficiaries

enrolled in TRICARE Prime to self-refer and receive non-emergency TRICARE covered services from any TRICARE-authorized provider, resulting in higher out-of-pocket costs and higher deductibles,” said Joan Head, head of TRICARE operations, NH Jax Department. “Prime enrollees choose to use the option, i.e., to obtain non-emergent health care services from other than their PCMs or without a referral from their PCMs.

“All requirements applicable to TRICARE Standard apply except the requirement for a non-availability statement,” she said. “Point-of-service claims are subject to higher deductibles and cost-shares even after the enrollment/fiscal year catastrophic cap has been met. Point-of-service is not an option and does not apply to active-duty service members.”

For patients away from home, who cannot wait until they see their PCMs for non-routine care, they must contact their PCMs for a referral before receiving services.

For more information, visit www.tricare.mil, TRICARE Service Center, at NBHC MCLB Albany, GA., or call the TRICARE South Region contractor toll free at (800) 444-5445.


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