TRICARE: Do You Need Emergency or Urgent Care? Published April 28, 2017 By TRICARE Staff TRICARE When you’re sick or in pain, it can be hard to determine the level of care you need. If a child or other family member needs care, the anxiety can be even greater. In those moments, you need to decide whether to go to an emergency room, an urgent care center, or to schedule an appointment with your Primary Care Manager (PCM). If your emergency requires an emergency room visit, you must also decide how you will get there. Learn about your emergency and urgent care options under TRICARE and be prepared. Emergency: If a condition threatens to your life, limb or eyesight, it is an emergency and a trip to the emergency room is necessary. Examples of medical emergencies include the inability to breathe, severe bleeding, spinal cord injury, chest pain, a broken bone, or maternity or psychiatric emergencies. TRICARE defines an emergency room as a hospital-based department available 24 hours a day providing emergency services to patients who need immediate medical attention. If you experience an emergency, call 911 or go to the nearest emergency room. You do not need prior authorization to receive emergency care with TRICARE. In all emergencies, your PCM or regional contractor must be notified within 24 hours or on the next business day following admission. This will allow them to coordinate ongoing care and to make certain you receive proper authorization. Based on your TRICARE plan, emergency care services may have applicable cost-shares. Emergency Transport: In an emergency you might need emergency transportation, either by land or by air. TRICARE covers the following ambulance transfers: Emergency transfers to or from your home, accident scene or other location to a hospital, and transfers between hospitals Ambulance transfers from a hospital-based emergency room to a hospital more capable of providing the required care Transfers between a hospital or skilled nursing facility and another hospital-based or freestanding outpatient therapeutic or diagnostic department or facility TRICARE does not cover: Ambulance service used instead of taxi service when the patient's condition would have permitted use of regular private transportation Transport or transfer of a patient to be closer to home, family, friends or personal physician Medicabs or ambicabs that transport patients to and from medical appointment Ambulance services if patients aren't taken to a hospital or other medical facility Please note: If you or someone else calls an ambulance on your behalf and you decide not to use the ambulance to go to a hospital or other medical facility TRICARE will NOT cover the cost of the ambulance service. When medically necessary, air evacuations are authorized to transport patients to the closest, safest location that can provide the required care. TRICARE covers air evacuations in extreme cases, but only if: An ambulance is unable to reach you The nearest facility is far away or there are other obstacles You must be seen quickly for your medical condition You cannot safely receive the care you need in your location Urgent Primary Care: You can visit an urgent care facility if you need treatment for an illness or injury that requires professional attention within 24 hours, but wouldn’t result in further disability or death if not treated immediately. Examples of urgent care include an earache, rising fever, or urinary tract infection. You can receive urgent care from your PCM or get a referral to receive urgent care from another provider. If you are unsure if you need urgent care, call the Nurse Advice Line (NAL) at 1-800-TRICARE (1-800-874-2273) and choose option 1. The NAL is available 24 hours a day, seven days a week. A registered nurse will confirm the level of care you need. Please note, the NAL is not for emergencies and is not a substitute for emergency treatment. To learn more about Emergency and Urgent Care, air evacuations (stateside and overseas), and coverage costs visit the TRICARE website.