New Tricare Nurse Advice Line Could Make Urgent Care Easier

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A new nurse advice line staffed by real humans available full time — including nights and weekends — to nearly all Tricare users could make getting seen at an off-base urgent care slightly easier.

The advice line, which you can reach by calling 1-800-874-2273 and hitting option 1,  is aimed at keeping family members who don’t actually need to be seen out of offices, and make sure those who do need to be seen head to the right place at the right time.

Edit: Tricare officials say that while you may have used something similar to this service in the past overseas or run by your local Tricare contractor, this is the first time one has ever been offered stateside Tricare wide to almost all beneficiaries with the ability to help you make appointments.

Once the line’s roll-out is complete operators will be able to help those seen at military treatment facilities get a same-day appointment or, if one is not available (or the office is closed) help them get an urgent care referral.

Since most non-Prime users don’t need a referral to hit up an Urgent Care facility, the line will be most useful to them for general advice.

For those of us on Prime here’s how the Urgent Care process works:

If you are enrolled in a military treatment facility:  If the nurse advice line tells you to go to urgent care because no same day appointments are available or because the MTF is closed, they will submit your referral to the MTF, which will then process it and send it to the urgent care facility. If the referral office is closed, they will process it retroactively.

If you are on Prime and seen by an off-base civilian provider:  If the nurse line tells you to seek urgent care, go ahead and do so — but you’ll need to follow-up personally with your doctor’s office to have them submit a retroactive referral.

The nurse line will be able to tell you which urgent care in your area is considered an “in-network” location. Make sure you go there — and not to one outside the Tricare network, or they won’t cover it.

Hold the phone. “Retroactive approval” sounds dangerous. I agree. In fact, I’ve had the local in-network urgent care turn me down because we didnt have a referral number already in their hot little hands.

But Tricare officials assured me that retroactive approvals are actually the norm. And, thanks to the roll-out of the advice line, commonly used urgent care locations around MTFs should be notified that they might seen an up-tick in patients.

“Over half of all referrals are given retroactively, which means patients have sought and received care from an urgent care facility without prior approval from their primary care manager,” said Tricare spokesman Kevin Dwyer. ” MTF enrollees who are visiting an urgent care facility requiring a referral reference number should state that they’ve called the Tricare Nurse Advice Line (NAL) and have permission to seek urgent care. Patients and urgent care facilities can also call the NAL at 1-800-874-2273 Option 1; the clerk can look up the patient’s NAL encounter to verify the patient was advised to seek urgent care.”

Here are some more helpful things to know about the new advice line:

They have pediatric specialists. And they’ll do a follow-up call for you. If you’re calling about something for your child, you’ll be forwarded to a nurse specifically trained in pediatric issues, Tricare officials said. And they will offer to follow-up with you later in the day just in case.

They are available all the time. The line promises a real human 24 hours a day, seven days a week. Helpful!

Some Tricare users aren’t covered — but not many. If you’re in the US Family Health Plan you can’t use the advice line. Everyone else is in.

If  you are stationed overseas but traveling stateside, you can still use it. If you happen to be back in the states and have a medical need, go ahead and call the advice line. However, if care is needed, you’re going to have to call your TOP Regional Call Center to coordinate.

They’ll let your MTF provider know you got help from them. If you’re enrolled at an MTF the nurse line will notify your provider that you received advice — and what the advice was.

 

About the Author

Amy Bushatz
Amy is the editor in chief of Military.com’s spouse and family blog SpouseBuzz.com. A journalist by trade, Amy also covers spouse and family news for Military.com where she is the managing editor of spouse and family content. An Army wife and mother of two, Amy has been featured as a subject matter expert on CNN.com, NPR, Fox News, NBC, CBS, ABC and BBC as well as in the New York Times, Wall Street Journal and Washington Post. Follow her on twitter @amybushatz.
  • Guest

    This is fantastic, thanks for posting!

  • AGRspouse

    The only problem with going to urgent care(in the civilian/remote stationed world) is: will your doctors office give a retro active referral for the urgent care facility you go to??? It doesn’t matter if it is on Tricare’s list–if your doctor will only refer to facilities in their “group” you get stuck with the bill. Trust me, been there, had that done to me. I called Tricare, was told to go to an urgent care, went to the closest one on Tricare Prime’s list. Doctor’s office REFUSED to write the referral, because they only refer to ‘their’ facilities. To heck with that the one I went to was only 5 minutes away and had free parking. The office wanted me to drive across town(at least a thirty minute drive) and park in a PAY lot, in the absolute WORST area in town. Maybe Tricare can inform Prime providers that they have to make referrals to NOT just their own group. We spent a fortune that we didn’t have on a bladder infection(that when I went into the doctor’s office for a follow up-she said that “oh, we don’t treat bladder infections. They always go away on their own”) Thank you Tricare that I didn’t have to pay more than the co-pay for the antibiotics or the painkillers that I needed.

  • ME Spence

    I almost had the same issue as AGRspouse. We had just joined TriCare, so we had not seen a Tricare primany care doctor yet. The day after we went to urgent care, I called the primary care doctor that was covered. They weren’t going to do a referral because we had not been seen by him yet. They finally agreed, but it was a big hassel. And he’s the only TriCare primary doctor within about 50 mile radius of us. I don’t understand why you need a referral to go to an urgent care anyway.

  • Armywife ER Doc

    I agree with ME Spence. WHY do you need a referral to go to Urgent Care?! I work in an ER and see WAY too many Tricare patients (like myself) that do NOT have an emergency. At least once or twice (usually more) on every shift, I hear patients or parents tell me, “I called the advice line and they told me to come to the ER.” The ER is NOT the dumping ground for patients that can be seen same day by their Primary Care or, even better, Urgent Care for non-emergent issues like colds, rashs, etc.

    • Tim

      The short… it is tax payer money and all efforts should be made for patients to actually seek care withing the Military Health System. What you said about the ER is true, however most UC centers close by 9pm.

  • Roland

    information is always good and this information sounds very useful. I am always afraid of what the bill will be that I always go to a military hospital for emergency care. but now I will call first. time is always a factor when you are in an emergent situation. but at least some one knowledgeable can direct me to a closer facility if need be. I was stuck with a large medical bill after my daughter had a seizer. but live and learn.

  • Mary Spinella

    I HAVE TRICARE FOR LIFE , BUT HAVE A PRIVET HMO. I AM ABLE TO GET A REFERIAL FROM MY DOCTOR TO SEE A SPECILIST. AND IS MEDICAL NESSARY. BEIGN ON MEDICARE AND I HAVE TRICARE FOR LIFE AM I ELEGIBLE TO GO TO ANY URIGENT CARE.WHO DO I CALL IF I NEED TO GO TO IN FOR URGENT CARE , AND WILL THEY DIRECT ME TO THE CLOSER FACILITY?

    • 1956-1976

      I’m never quite sure how these new programs effect those of us in the “Geezer Brigade.” I, too, fall into the Tricare For Life category.

  • a m

    So this pretty much changes nothing for people not enrolled at an MTF.

    • Amy_Bushatz

      Sort of. We’re seen outside an MTF, so you better believe I was thinking about “yes but how does this impact ME?”

      First of all, I am grateful to have access to an advice line, which our office doesnt have off-hours. So for us that’s new.

      And I also think the urgent care help can be useful for us non-MTF folks. I know the Tricare PAO folks SAY that my referral will be done retroactively, but frankly my BS-meter says “yeah it is definitely not going to be that easy.” I think being armed with a “YOUR nurse advice line told me to” is going to be helpful with getting Tricare to give it the retroactive stamp. I know I won’t have trouble getting my doc’s office to push it through … but after it leaves there who knows?

  • Catherine

    Since we chose Tricare Standard upon retirement, none of this changes anything for us. We LOVE Standard because we get to go to whomever we want, whenever we want, wherever we want, and have no annual enrollment fee. I can count on one hand how many referrals we have needed in the last 14 years, and those few had to do with surgery. We have never been denied anything by Tricare. And…since all of the Providers (including Specialists), Urgent Care facilities and Hospitals in our area are “Participating Providers”, we end up paying Tricare Extra rates. (20% of Tricare’s allowable compared to 25% for Retirees) And before anyone asks….the nearest MTF is is over 100 miles away.

    • Allison Wall

      Catherine – you are so smart. We have Standard now while active duty and when I realized the other day that retirees have to PAY for the insanity that is Prime, I thought that was CRAZY. Why would anyone, ever, pay for that insanity? Husband is still about 4 years from retirement, but now that I know there’s no fee for Standard in retirement, I am looking forward to staying Standard for all the reasons you wrote!

      • Catherine

        Awwww, you’re sweet. You’re welcome. Not so sure about the smart thing though. Just a lot of years of dealing with it all. My father is retired USAF and it was CHAMPUS back then. Went from being a military brat to a military wife. Loved it all, and was pleased that when hubby retired I saw that not much has changed between the old CHAMPUS and Tricare Standard. Glad I could help.

  • Margaret Sanchez

    TRICARE for Life and Medicare are a different ball game. Will someone please answer the question concerning the Baby boomers?

  • Catherine

    You cannot use TFL unless you are enrolled in Medicare Part B. Medicare will pay first and Tricare will pay the rest. There are very few things that you will be responsible for between the two. Hope this helps.