Emergency and Urgent care, not the same

Published Feb. 5, 2009
By Ric Carlson
21st Medical Group

PETERSON AIR FORCE BASE, Colo. -- Differences exist between "emergency" medical care and "urgent" care. They are not the same and the differences are an important matter.

TRICARE defines the two types of care when a person enrolled in the Department of Defense Health Maintenance Organization's TRICARE Prime travels outside their TRICARE region seeking treatment as an:

Emergency:
-- Emergency care is covered for medical, maternity or psychiatric emergencies. These are a sudden and unexpected medical condition, or the worsening of a condition that a sensible lay person would pose as a threat to life, limb or eyesight and requires immediate treatment. The situation may also include a sudden, extremely painful condition, which requires immediate treatment to alleviate suffering.

-- Pregnancy-related medical emergencies involve sudden and unexpected medical complication that puts the mother, the baby, or both at risk. In the case of pregnancy, TRICARE does not consider a delivery after the 34th week of an emergency.

-- If in need of emergency care: Go directly to the emergency room at the nearest hospital or call 911, if available in your area. When a person as a TRICARE Prime enrollee receives emergency medical care and is hospitalized without a primary care manager being involved, the enrollee must contact the PCM within 24 hours at 556-CARE, or the managed care contractor at 1-888-TRIWEST.

If not enrolled in TRICARE Prime, a person does not need to make the aforementioned notification since the enrollee does not have a primary care manager.

Urgent Care:
-- Is medically necessary treatment that is required for illness or injury that would not result in further disability or death if not treated immediately, but treatment should not be put off. The illness or injury does require professional attention, and should be treated within 24 hours to avoid development of a situation, in which further complications could result if treatment is not received.

-- Examples of conditions that should receive urgent treatment are: sprains, scrapes, earaches, sore throats, rising temperature -- conditions that are serious, but are not life-threatening.

Enrollees can get urgent care at various locations, including a PCM's office, when enrolled in TRICARE Prime, and at urgent care centers. A TRICARE Prime enrollee can call their PCM at 556-CARE for advice and further assistance.

If enrolled in TRICARE Prime and away from the service area, TRICARE Prime will cover emergency care. Be sure to notify your PCM or the MCC within 24 hours. If you have to pay an up-front, out-of-pocket expense (other than normal TRICARE Prime co-payment) for emergency or urgent medical care, the TRICARE contractor will reimburse in accordance with the provisions of TRICARE Prime coverage. Check with your nearest TRICARE service center for details on how to get reimbursed.