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6th MDG releases info for off-base care at UCCs and ERs

Editorís note: As the closure of the 6th Medical Group Emergency Department July 1 nears, several articles will appear in the Thunderbolt to address patients' concerns and issues with using community facilities for urgent and emergent care. The questions this week address the process of obtaining care at those facilities.

Do I proceed to an urgent care center or an emergency room?

If you believe that a serious medical condition exists that would result in a threat to life, limb or eyesight, proceed to the nearest ER. If care is needed for a problem that does not meet the criteria listed above but cannot wait until a time when your primary care manager is available, proceed to a UCC.

Where can I go to receive after-hours care?

Fortunately, the Tampa Bay area has a robust health care system. There are numerous UCCs and ERs where after-hours urgent care or emergency care can be obtained. A good rule is to determine which facility you would use before care is needed. Area UCCs have different hours of operation, while ERs are open 24 hours a day. Individual UCCs may also have restrictions on the age of patients they will treat. To locate a TRICARE network UCC, call the Provider Locator at 800-444-5445 and follow the prompts. You can also go online at www.humana-military.com, beneficiary resources, select provider locator, and choose your UCC. The location of nearby non-network UCCs can be found in your local telephone directory. You will need to ensure, however, that the UCC is TRICARE certified in order to be reimbursed for the cost of the visit.

How do I know if a non-network UCC is TRICARE certified?

There are two ways to determine if the non-network UCC you plan to use is TRICARE certified. Call the UCC and ask if they accept TRICARE. If they do, a good follow-up question is, "Does your clinic bill TRICARE or will I have to pay at the time of the visit?" If the non-network UCC is TRICARE certified but requires payment at the time of the visit, you can bring the bill to your local TRICARE Service Center, where you will be assisted for reimbursement.

What procedures do I follow after my visit?

TRICARE Prime members should contact their PCM within one duty day after a visit to an UCC or ER. This will allow appropriate follow-up care to be scheduled and expedite the claims payment process. The PCM will provide a retroactive authorization for the care provided, which will allow TRICARE payment for the visit. Your health is the primary concern of the 6th Medical Group.

Will I be charged for my visit at a community facility?

If you are a TRICARE Prime enrollee and you are treated in a TRICARE network UCC, you will not be required to pay for the care at the time of the visit. If you are treated at a non-network certified UCC, you may have to pay for the care at the time of the visit. If you are required to pay upfront for your UCC visit, you may print and fill out the claim form (DD Form 2642) located on the Humana-Military Website (www.humana-military.com.)

The form can be found under beneficiary resources/ TRICARE forms. The instructions and address for submitting the claim form are on the Website. If you are unable to access the form or if you have additional questions, please bring your bill to the TRICARE Service Center adjacent to the 6th MDG Hospital. Personnel will assist you in filing the claim to ensure you are reimbursed for your visit. Allow two to three weeks for claims to process. If you receive a bill for an ER visit, bring your claim to the TRICARE Service Center.

What if I am a TRICARE Standard/Extra member?

If you are a TRICARE Standard/Extra member you are subject to the annual deductibles and co-pays associated with your TRICARE status. Under TRICARE Standard/Extra you may see any TRICARE-approved provider.

Who can I contact for more information?

Questions regarding medical benefits on any TRICARE programs can be answered by contacting Humana Military Healthcare Services, Inc at 800-444-5445 (www.humana-military.com) or by visiting the TRICARE Service Center. (Courtesy of 6th Medical Group)



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