Urgent Care referral policy undergoes changes

  • Published
  • By 78th Medical Group
Starting Feb. 1, the option to call and leave a message to notify the 78th Medical Group clinic staff that you have been to or are going to urgent care will no longer be available.

For after-hours medical concerns TRICARE beneficiaries are required to contact the on-call medical provider; they will receive either home-care instructions or authorization to go to an urgent care facility. The decision is made by the on-call provider. During duty hours, all beneficiaries must call Central Appointments at commercial 327-7850 for an appointment or place a telephone consult to their Family Health Provider or Team. The change in policy is necessary to remain compliant with TRICARE regulations.

TRICARE regulations require that beneficiaries receive prior authorization before receiving acute care at an Urgent Care or Med Stop facility.

Furthermore, if a necessary approval is not obtained before receiving care, the claim for the service will be processed under the Point-of-Service option, resulting in higher out-of-pocket costs. Many times a patient's acute care needs and concerns can be treated with home- or self-care care options.

The 78th MDG has providers on call to answer acute medical concerns or issues. After contacting the on-call provider or FHT, he or she may determine it is necessary for the patient to seek medical attention at a local urgent care facility or provide home care. The on-call provider will provide authorization, a recommendation to see a specific urgent care center, and send a referral to TRICARE the next duty day.

If there are concerns about payment and TRICARE policies, visit The TRICARE Service Center located in Bldg. 700 or or Stop by or call with further questions concerning your health care and benefits.