Tricare Prime Remote and Urgent Care — The Bump
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Tricare Prime Remote and Urgent Care

I have a question for any of you ladies that have or have had tricare prime remote.We are traveling for the holidays and my 2 year old is super sick. I'm thinking we can do an urgent care instead of the hospital but I remember reading a referral is needed for that. Anyone know how I go about getting one on a holiday weekend with offices being closed? Or is taking her to the ER just easier? We haven't had tricare very long and I've only ever had to use it for visits to the primary care doctor...so I'm lost! Thanks in advance for your help
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Re: Tricare Prime Remote and Urgent Care

  • I went right into urgent care with no problem. I didnt need a referral or anything. As long as you have your military ID you should be good.
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  • If you're worried about it, call Tricare on Wednesday or Thursday of next week and let them know about it.  But, they should cover an urgent care.
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  • TRICARE PRIME WILL NOT COVER URGENT CARE WITHOUT A REFERRAL.

    You need to try and get in touch with the physician on call and tell them you would prefer Urgent Care to the Emergency Room. 

    I have been to Urgent Care twice this year with my kids (they are Prime).  Both times we have had to call our PCM (or the on-call doctor) and explain the situation.  Once we got the "blessing" to go to Urgent Care we were given the instruction to call back after being seen with the information of the facility, doctor name, diagnoses, and other random things.  Basically, keep your reciept and call back so they can submit a referral into the system.

    If Tricare is billed by an Urgent Care facility without the referral in the system they WILL kick it back out and not pay.  You will recieve a bill from the Urgent Care.  Many Urgent Cares don't take insurance to begin with.  In that case, you need to pay up front, get your referral in and then fill out the Tricare paperwork for reimbursement. 

    Urgent Care and the Emergency Room are different beasts with Tricare.  Tricare WILL cover ER visits without a referral.  They will NOT cover Urgent Care visits without a referral.

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  • We have prime remote and we just go to the walk in (that's connected to the ER). I've never had an issue without a referral.
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  • You can call Tricare and get a direct one time referral. I did it once for a UTI a week after our last move when my new PCM wasn't set up yet. It took about 10 minutes and they approved an urgent care visit. You may have to pay upfront, but if you get the referral they will reimburse you. You can also go to the ER, Tricare will cover that completely.
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