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Thread: Covered under Tricare prime?

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    #1

    Covered under Tricare prime?

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    Quick question, my friend took me to the closest hospital earlier today because I am 32 weeks pregnant and was having trouble breathing because I was throwing up and very dizzy all day. I called the on duty nurse at the military hospital first, and she said if my conditions didnt improve I needed to come in. Even though I didn't go to a military provider, do you think the emergency room visit was covered under Tricare prime? Thanks
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    #2
    Yes, in an emergency you can go to a local ER. Used to be you had to call Tricare within 24 hours of being seen to get an authorization, but I haven't done this in a few years.
    Go to the Tricare website and check.

    TRICARE Prime
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    #3
    Where I am I have to call the Tricare Nurses hotline and get approval to go before I do. But if it is a real emergency and you don't get approval first you will still be covered by tricare.
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    #4
    If I have gone to the emergency room, I do not call Tricare first. I know they usually say to do that for approval, but I just call them within 24 hrs of going (if I remember) and I have never had a problem. Also if it is at night or on the weekend, there really is nowhere else to go so if you call tricare that is where they are going to tell you to go. I mean in the cases where I have had to go it is either, my son can't breath, my son has split his head open and someone is in a LOT of pain.
    I have always been told if you/patient can't bleed, could loose a limb or their life just go straight there, do not call.


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    #5
    I have never called for going to an ER if the base facility does not have an ER. Now if your base facility has an ER and you didn't go there but you could have than they can deny the claim.
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    #6
    Back in the day you used to have to call TriCare within 24 hours of visiting an ER...thats not the case anymore. You are absolutely covered for ER visits regardless if you went to a military provider or not. TriCare states that if you have an emergency go to the closest ER regardless.
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    #7
    Quote Originally Posted by USMCWife03 View Post
    Back in the day you used to have to call TriCare within 24 hours of visiting an ER...thats not the case anymore. You are absolutely covered for ER visits regardless if you went to a military provider or not. TriCare states that if you have an emergency go to the closest ER regardless.
    Well you are still suppose to call tricare within 24 hours. But yes apparently tricare does now say if an emergency go to the nearest ER.

    So it would come down to (and I am not saying it is or isn't) if tricare will deem her issue an emergency.

    For instance, I was told that if I can make it to a mcf than I need to go there if they have an er unless it was life or death.

    Now I have not lived near a base that has had an emergency room at the hospital in the past 3.5 years so I have always had to go to a civilian er regardless so if things have changed I really did not know.
    Last edited by Southern-queen; 11-15-2010 at 10:59 AM. Reason: changed to phrase better.
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    #8
    I went to the ER a couple weeks ago. We were visiting family so it was a civilan hospital. I never called Tricare, just didn't cross my mind really cause I was in so much pain. They billed my Tricare and sent me the copy of the bill. Haven't heard anything about them not paying it.
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    #9
    Quote Originally Posted by Southern-momma View Post
    Well you are still suppose to call tricare within 24 hours. But yes apparently tricare does now say if an emergency go to the nearest ER.

    So it would come down to (and I am not saying it is or isn't) if tricare will deem her issue an emergency.

    For instance, I was told that if I can make it to a mcf than I need to go there if they have an er unless it was life or death.

    Now I have not lived near a base that has had an emergency room at the hospital in the past 3.5 years so I have always had to go to a civilian er regardless so if things have changed I really did not know.
    My son had to be taken by ambulance to the hospital 4 years ago and we were so concerned about calling within the 24 hours so we did and they told us thats not longer necessary. Since then we have all been to the ER lots of times and never had to call and never been an issue/

    I went to the ER about 3 months ago with stomach pain...we live on base about a minute from the military hospital and I went out in town to the civilian hospital since my husband had a horrible experience at the hospital on base when he went...wasn't life or death but I was in pain...didn't call TriCare and they completely covered it even though I went to the civilian hospital. We are from Pensacola so on leave there have been a couple times over the years where we needed an ER and didn't use the Naval Hospital there and never had any issues.

    It really does not matter which ER you go to...all ER's are severely overcrowded these days so its not like the military hospitals are lacking business and all someone would have to say if there was ever a question was that the wait was entirely too long at one over the other.
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    #10
    I went to the ER out of state when my H and I were pcsing to Cali.. We tried the on base hospital that we were close to in Wyoming, but they didn't have an ER, and the clinic was closed. I had a severe UTI/bladder infection and was urinating bright red liquid. I had never had a UTI or bladder infection before so I waited to go to the dr. bad decision! Anywho, Tricare paid the hospital bill, but the physician that cared for me denied the amount that Tricare offered to pay her.. What do I do now? Am I really responsible for that? Can she really do that? What is the point of having insurance if the doctor can just refuse to accept the insurances' allowed amount?


    "Notice that the stiffest tree is most easily cracked, while the bamboo or willow survives by bending with the wind. ~ Bruce Lee


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