Tricare pilot program will allow families to use in-network urgent care
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published: May 04, 2016
Some Tricare users will soon be allowed to use in-network urgent care providers without receiving any authorization under a new Tricare pilot program set to start May 23, according to policy documents released Tuesday.
The three-year pilot, ordered by Congress as part of the 2016 National Defense Authorization Act, will allow most Tricare users two urgent care visits per beneficiary, per fiscal year without official authorization from a provider or official. After those two visits have been used, beneficiaries can continue to use urgent care as long as they receive a referral.
“The purpose of the pilot is to ... determine if the elimination of the requirement to obtain a referral or preauthorization for urgent care visits improves access to urgent care, helps enrollees to choose the most appropriate source for the health care they need,” according to a Tricare statement. The aim is to see if it “potentially lowers health care costs for the Department of Defense (DoD) and/or improves patient satisfaction.”
Currently Tricare Prime users must receive prior authorization to visit an urgent care. Emergency room visits, however, are free. Because of that military families often default to emergency room use when they cannot get an appointment with their primary care provider, military family watchdogs say. The urgent care pilot program, they say, is aimed at fixing that.
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