Understanding Emergency, Urgent and Routine Care

  • Published
  • By Shari Lopatin and Capt. Tom Lipscomb
  • TriWest Healthcare Alliance
EDWARDS AIR FORCE BASE, Calif. --  When sickness or injuries strike, Edwards Airmen and their families can avoid frustration as well as save time and cash by knowing the differences between emergency, urgent and routine care.

Confusing a moderate steady fever as urgent or a sprain as an emergency can mean longer waits and more out-of-pocket costs. Active duty service members and their family at Edwards should know the differences and appropriate methods for accessing each type of care.

Anything that reasonably could threaten life, limb or eyesight without immediate treatment is considered an emergency by TRICARE. This includes maternity and psychiatric emergencies that are believed to be serious medical conditions. Examples of emergency situations are: severe bleeding, chest pains, no pulse, inability to breathe, spinal cord or back injury, severe eye injury and broken bones. 

In an emergency, Edwards Airmen or their families should call 911 or visit the nearest emergency room. An authorization from TRICARE is not required prior to an emergency room visit. However, TRICARE patients are encouraged to call either TriWest Healthcare Alliance at 1-888-TRIWEST (874-9378) or the 95th Medical Group at 661-277-7118 within 24 hours after the visit - especially if the visit resulted in an inpatient admission.

Emergency care is more expensive than urgent and routine care, averaging over $800 per visit in FY 2009.  Wait times for emergency care can also be quite lengthy depending on the severity of the illness or injury.  Going to the emergency room for non-emergent needs can result in wait times of several hours to receive care, as patients with more emergent needs will be seen first. Because of the costs and wait times associated with emergency care, visits to the emergency room should be limited to true emergencies.

An illness or injury that won't cause further disability or death if not treated immediately, but needs medical attention to keep it from evolving into a greater threat, requires urgent care. Examples of urgent care include: minor lacerations, urinary tract infections, earaches, migraine headaches, sprains and rising fever.

Airmen and their families should use civilian urgent care during non-duty hours, weekends, and holidays. The 95th Medical Group nurse advice line, 866-535-4137, is available for patient consultation to determine what care is needed, then facilitate a visit to an urgent care center if necessary. For urgent care needs during duty hours, call the 95th Medical Group appointment line at (661) 277-7118 to schedule an appointment.

If families are not sure whether the situation is urgent or an emergency, please call the nurse advice line for clarification.  An authorization from TRICARE is required for a visit to a civilian urgent care facility. Families that don't receive an urgent care authorization may be billed for TRICARE Prime's point-of-service option, which includes additional cost shares and a deductible.

Urgent care costs and wait time are significantly lower than emergency room visits. The average cost of an urgent care visit is less than $100 and the wait times at local urgent care facilities is normally less than one hour.

TRICARE defines routine care by what it's not. If it's not an emergency and it doesn't qualify as urgent care, then it is routine care.

Also known as primary care, routine care can include well-baby and child care, preventive care appointments, general office visits for treatment of symptoms, follow-up care with the doctor or ongoing care for chronic illnesses and conditions. Routine care is provided by medical professionals at the 95th Medical Group. To schedule a routine appointment, contact the appointment line at 661-277-7118. The appointment line is open from 7 p.m. to 4 p.m. on normal duty days.