When to go to the ER, UCC

  • Published
  • By Lt. Col. Theresa A. Murphy
  • 66th Medical Squadron
When you or a member of your family is sick, you probably call a Military Treatment Facility and either schedule an appointment or get advice on what to do at home. But what happens after the MTF is closed?  Who do you call and where do you go?

Many lean towards going to the nearest emergency room, whether the condition is emergent or not. But that might not be the best option.

In a Centers for Disease Control report published earlier this year, approximately 20 percent of U.S. adults sought health care at an ER in 2013 and 2014. However, many of those ER visits could have been managed at an Urgent Care Center.

If these visits had occurred at a UCC, "...the potential savings to the health care system would be approximately $4.4 billion annually," according to a Department of Health and Human Services report.

When deciding to visit the ER or the UCC after hours, below are some general guidelines to follow.

Those experiencing the following emergent symptoms should go to the nearest ER or call 911:

-Threat to life, limb, or eyesight, or requires immediate medical treatment.
-Chest pain or pressure, or severe heart palpitations.
-Immediate risk of serious harm to self or others.
-Inability to breathe.

A more complete list of symptoms can be found on the National Institutes of Health's website at https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000593.htm or TRICARE's website at http://www.tricare.mil/CoveredServices/IsItCovered/EmergencyCare.aspx?sc_database=web.

You should call 911 if you cannot quickly get to an ER, or if you cannot safely drive. This is especially true when experiencing heart attack or stroke symptoms, as emergency medical technicians and paramedics can give life-saving care on the way to the ER. 

For Military Treatment Facility (MTF) patients, emergency care does not require a referral. However, when using emergency services for non-emergent or routine reasons, patients may receive a bill. If you are enrolled in TRICARE Standard and have a co-pay, it will likely be twice what it would be for a UCC visit. ERs tend to have longer wait times than UCCs, as patients are sorted or triaged, and the most emergent patients treated first. For those enrolled to a MTF, such as the Hanscom clinic, patients should contact their primary care manager within 24 hours, or the next business day, after receiving emergency care to ensure the right follow-up care.

For those who have symptoms that are not emergent but can't wait until the MTF is open, you should call the Department of Defense TRICARE Nurse Advice Line (NAL) for advice or authorization to seek urgent care at a UCC.

Some symptoms that are considered urgent are:

-Issues that don't threaten life, limb or eyesight.
-Minor cuts.
-Painful urination or Urinary Tract Infection.

Visits to a UCC require a referral, which can be obtained after hours by calling the NAL at 781-225-6789 (this line will transfer to the NAL after hours).

When using urgent care from a non-network provider, or without a referral from a medical provider, patients will be using the TRICARE point-of-service option and will receive a bill. If you are enrolled in TRICARE Standard and you have a co-pay, it will likely be half of what it would be for an ER visit.

So why should I care? My healthcare is free.

While it may seem that your healthcare is free and you do not pay for visits used, if you use services inappropriately, you might get a bill that TRICARE will not pay. 

Additionally, using ERs and UCCs for care that could be obtained at the MTF also costs the DOD more money than necessary. In 2015, Hanscom paid $1.2 million in ER and UCC bills. Eventually service members will retire or separate from the military, and then the cost for TRICARE Prime or Standard may be increased due to those unnecessary or inappropriate visits.

If you follow these guidelines, you can avoid unnecessary costs to both you and the MTF, and longer than necessary wait times. 

For further information, or to ask a question, either send the clinic a MiCare message, ask your medical provider team when you are in for an appointment, or call us at 781-225-6789. 

The 66 MDS team is ready to assist you as your "trusted partner in health and leader in readiness."

For more information, visit the Health Net Federal Services websites at https://www.hnfs.com/content/hnfs/home/tn/bene/auth/phone-first.html, https://www.hnfs.com/content/hnfs/home/tn/bene/auth/emergency-care.html or the Nurse Advice Line website http://www.tricare.mil/ContactUs/CallUs/NAL.aspx.