Tricare/ER question — The Bump
Military Families

Tricare/ER question

The other day my 2 friends and I were in a fender bender in a Sonic parking lot. We were stopped waiting to turn into a parking stop and the guy in front of us (for some reason?) decided he needed to go backwards. He put it in reverse and really flew into us. The driver honked the horn the whole time and tried to put her car in reverse but she couldn't move fast enough. He hit us hard enough that we all got a huge jolt. I went to the ER just to make sure everything was ok with the baby (we found out its a BOY!) They took me to the Naval hospital on base and I waited 2 1/2 hours by the time my husband got there after he got out of work. He was livid I hadn't been seen yet so he told the reception to take me off the list and we are going out in town. As soon as we got to the other hospital they had me hooked up within 15 minutes monitering the baby, taking my vitals and some blood and gave me an u/s (everything was fine). My question is do I need to call Tricare to let them know we did that? We went in through the ER but I didn't fill out any paperwork and they took me right up to L&D so I didn't know if that made a difference. I know if you go in the ER at any hospital Tricare will cover. Any thoughts?

Re: Tricare/ER question

  • Yes. Call TriCare and tell them you were in an accident and seen in an ER off post.  There shouldn't be any issues.
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  • I think your supposed too - but the last time I went to the ER I didn't call. 
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  • Per the TRICARE HANDBOOK

    TRICARE defines an emergency as a medical, maternity, or psychiatric condition that would lead a ?prudent layperson? (someone with average nowledge of health and medicine) to believe that a serious medical condition exists; that the absence of immediate medical attention would result in a threat to life, limb, or sight; when a person has severe, painful symptoms requiring immediate attention to relieve suffering; or when a person is at immediate risk to self or others.

    You do not need to call your PCM or regional contractor before receiving emergency medical care. However, in all emergency situations, you must notify your PCM within 24 hours of or on the business day following admission to coordinate ongoing care and to ensure you receive proper authorization.

    If you do not get proper authorization in the system, TRICARE will not pay the bill.

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  • imageIlumine:

    Per the TRICARE HANDBOOK

    TRICARE defines an emergency as a medical, maternity, or psychiatric condition that would lead a ?prudent layperson? (someone with average nowledge of health and medicine) to believe that a serious medical condition exists; that the absence of immediate medical attention would result in a threat to life, limb, or sight; when a person has severe, painful symptoms requiring immediate attention to relieve suffering; or when a person is at immediate risk to self or others.

    You do not need to call your PCM or regional contractor before receiving emergency medical care. However, in all emergency situations, you must notify your PCM within 24 hours of or on the business day following admission to coordinate ongoing care and to ensure you receive proper authorization.

    If you do not get proper authorization in the system, TRICARE will not pay the bill.

     

    nice to know that!  I think I better be more diligent next time in regards to calling them. 

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  • RosTor - if you talked to your PCM w/in a 48 hour period, he/she could have backdated an authorization for you as well.  I have even known a provider to slip an auth in 72 hours later (before the hospitals bill hit WPS). 

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  • My husband had to go to the ER during a PCS and we were at our new assignment but the MTF was closed for the holiday.  When we called Tricare they said my DH would be covered as long as it was an emergency since the MTF wasn't open, but to our knowledge he would have not been covered if he chose the private hospital over a military hospital or MTF that was open.  Definitely call Tricare if you haven't yet and explain the situation!
  • I had to go to the ER off base one time when I was pregnant for a pre-labor scare and I never called Tricare, and everything went perfect. I was never notified or anything. I just recieved my paper in the mail saying Tricare had covered it.

    Needless to say, after that I decided to have my son off base, Lol.

  • They did run my insurance in the ER when the registered me (I had never been there before). She even told me if I feel like I'm not fully satisfied at the Naval hospital I can come in through the ER there when I am ready to deliver and it will be 100% covered and that a lot of people do that. I asked her if I needed to call and she said "Nope, you're all set it will be covered." I'm just nervous to get a huge bill in the mail! I think I'll call just to be safe :) Thanks everyone!
  • At over 20 weeks pregnant you should not have been in ER triage at all at the Naval hospital (they should have sent you to L&D immediately).  You should contact the patient advocate at the Naval hospital and file a complaint as well.
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