Avoid out-of-pocket expenses

  • Published
  • By Barbara Allen
  • 2nd Medical Group
BARKSDALE AIR FORCE BASE, La. --  Would you like to do your part to fight the rising cost in healthcare? The 2nd Medical Group is trying to do just that. The cost of visiting a downtown urgent care center is about $150 to $200 per visit. We are proud to say we now have more appointments available than ever before. Because of that, we are able to see more of our beneficiaries on base versus sending them to a downtown urgent care center. However, doing our part in reducing this cost requires us to make some changes in the process.

Effective March 1, all TRICARE beneficiaries enrolled to Barksdale must have authorization prior to seeking care at a downtown urgent care center. If you seek care without prior authorization, you may be responsible for some or all incurred charges.

Urgent care is treatment for an illness or injury that requires medical attention within 24 hours to avoid further complications. These are medically necessary treatments, but won't result in further disability or death if not treated immediately. Some examples of urgent care situations include minor lacerations, urinary tract infections, migraine headaches, sprains, rising fever and possible ear infections. Illnesses or injuries more severe than this require emergency care.

TRICARE defines an emergency as a medical condition creating a threat to loss of life, limb, eyesight or unrelieved pain as perceived by a "prudent layperson" - someone with limited knowledge of health and medicine. Some examples of emergency situations include severe bleeding, chest pains, no pulse, severe difficulty or inability to breathe, severe back injury, eye injuries and broken bones. For emergency care, call 911 or go directly to the nearest emergency room. Please contact your provider the next duty day to follow up on your visit. This ensures your provider is aware of your medical situation and increases the continuity in your care.

Urgent care centers should be used when your family health team is not available. This may occur when the 2 MDG is closed on weekends, federal holidays, training days, etc. and outside of clinic hours Monday through Friday, 7:30 a.m. to 4:30 p.m. It may also occur if an appointment is not available within Department of Defense mandated access-to-care standards.

During duty hours, TRICARE prime beneficiaries enrolled to the 2 MDG must call the appointment line at 456-6555 to request an appointment. For urgent care needs, you will be offered the next available appointment within the 24-hour access standard. Every effort will be made to schedule the visit with your family health team. If an appointment is not available within the DoD access standard, you will be given authorization to go to a local TRICARE-approved urgent care center.

After hours, on weekends and holidays, authorization may be obtained by calling 456-6555 and speaking with an on-call provider. The provider will evaluate your medical situation. Based on this evaluation, you may be directed to an urgent care center, an emergency room, or you may be given home healthcare directions. Prior to seeking urgent care in the network, you must have authorization from your family health team or the on-call provider. Seeking care without authorization may result in out-of-pocket expenses.

Following the guidance of TRICARE policy, beneficiaries that do not call to receive authorization will be billed under the TRICARE prime point-of-service option, for non-active-duty. The POS option requires out-of-pocket payment for the medical bill incurred. The POS option does not apply to active-duty military members which may result in higher out-of-pocket expenses.

There are no 24-hour pharmacies in the Shreveport-Bossier City area that accept TRICARE. We have addressed this issue with local emergency rooms and urgent care centers by asking them to provide the first dose of medication. If you cannot wait until the next day to purchase medications, there are two 24-hour Walgreen's in the area. If you go to one of these two, you will have to pay full price for your prescription and file a claim with TRICARE to be reimbursed.

For more information about your TRICARE benefits, visit www.humana-military.com, call 1-800-444-5445, or visit the local TRICARE service center at the 2 MDG.

We strive to ensure you receive the best care possible. For issues or concerns, you may also contact our 2 MDG health benefits advisor at 456-6405 or the 2 MDG patient advocate at 456-6360.