What to do: After hours medical care for TRICARE Prime beneficiaries

  • Published
  • By 2nd Lt. Jennifer Chenoweth
  • 28th Medical Support Squadron TOPA flight commander
What should Airmen do if they fall and twist their ankle in the middle of the night? Where can they go if their child has a fever?

Sometimes not knowing what to do is more frightening than the medical problem itself, but it is important to know where to go and how to obtain care.

All TRICARE beneficiaries need to understand the difference between urgent and emergency care, so that they can receive the appropriate care as quickly as possible.

An urgent healthcare condition is an illness or injury that won't cause further disability or death if not treated within 24 hours, but does require professional intervention to prevent it from developing into a greater health threat.

Some examples of urgent care include but are not limited to:
· Minor cuts
· Urinary tract infections
· Migraine headaches
· Sprains
· Rising fevers
· Possible ear infections.

An emergency healthcare condition is a medical condition that creates a threat for loss of life, limb, eyesight or unrelieved pain.

Some examples of instances where emergency care is required include the following:
· severe difficulty or inability to breathe
· severe back injury
· severe eye injuries
· fractures

In an emergency, a beneficiary should always go directly to the nearest emergency room or call 911, but they are also required to contact their primary care provider or TriWest within 24 hours of the emergency room visit.

Ellsworth's TRICARE Prime beneficiaries requiring urgent care need to contact the 28th Medical Group at (605) 385-6700. Customer Service is available 24-hours a day, seven days a week.
If patients need to call during normal duty-hours,(7:30 a.m. - 4:30 p.m.) they need to choose option five after dialing, and then follow the instructions provided by the appointment clerk.

After performing these functions, a telephone consult may be placed with the beneficiary's primary care team and a team member will call back with additional instructions as soon as possible.

The primary care team will do everything possible to have the beneficiary seen within 24 hours, and if they are unable, they will authorize you to seek care in the local healthcare network.

If a beneficiary requires urgent care after duty hours, they need to select option two to connect to the 28 MDG nurse advice line. The advice line will then provide the beneficiary with additional instructions or grant authorization to seek care in the local healthcare network.

If a beneficiary wants to speak to a physician, they should notify the triage nurse, who will then forward the request to the on-call physician who will contact the beneficiary as soon as possible.

If a beneficiary is travelling outside the local area and requires urgent medical care, they should follow the same instructions as above, but also remember to tell the individual on the phone they are out of the local area.

After beneficiaries have been authorized by the nurse advice line or staff to seek local care, they may utilize several TRICARE-approved urgent care facilities. These facilities include the following:

Rapid City
Black Hills Pediatrics and Neonatology - (605) 341-7337
Creekside Family Practice - (605) 341-1208
Family Practice Residency Program - (605) 719-4060
Rapid City Community Health Center - (605) 394-6666
Rapid City Medical Center, Midtown (Dr. Waltman only) - (605) 348-2273
Rapid Care - (605) 341-6600

Custer Regional Medical Clinic - (605) 673-4150

Edgemont Regional Medical Clinic - (605) 662-7250

Hill City
Hill City Regional Medical Clinic - (605) 574-4470

Hot Springs
Family Health Clinic of the Southern Hills - (605) 745-5188

Queen City Medical Center - (605) 642-8414
Spearfish Health Center - (605) 642-2030
Spearfish Regional Medical Clinic - (605) 644-4170

Massa Berry Clinic - (605) 347-3616
Dakota Hills Family Practice - (605) 720-1389
Black Hills Family Practice - (605) 720-4520

The Rapid Care clinic is the only clinic that sees patients on a walk-in basis. All others in the local healthcare network require patients to call in advance and make an appointment for their urgent care visit.

If beneficiaries do not follow these steps to get proper authorization for urgent care, they risk being billed under the TRICARE Prime Point-of-Service option, which requires the sponsor to pay an out-of-pocket deductable and co-pay expenses.

For additional information about TRICARE benefit, please visit www.triwest.com, call (888)-TRIWEST (874-9378) or visit the local TRICARE Service Center located in the 28th Medical Group clinic.