By Tereasa WadeNovember 23, 2016
FORT LEE, Va. (Nov. 24, 2016) -- Before heading out of town for the holidays, take heed of these reminders of the procedures for traveling with TRICARE Prime:
• Plan ahead for routine care -- Remember, as TRICARE Prime enrollees, individuals are required to obtain all routine care from their primary care manager. Routine care includes management of chronic health conditions, routine physicals, and requests for prescription refills. If the care can be handled before leaving or can be delayed until the return home, it is considered "routine care."
• Prescriptions on the road -- The best practice is to have enough prescribed medications to cover the time away. If a refill is due while not in the local area, the PCM can authorize a short term "vacation" fill to ensure beneficiaries will not run out. Make sure to call at least a week before leaving to allow adequate time for the prescription to be filled. If prescriptions are received through TRICARE's mail order service and will be due for a refill while traveling, it is important to contact Express Scripts to let them know an alternate address to which to ship the medications.
In an emergency, contact the PCM and ask for a prescription to be faxed to a local pharmacy. Be cautious if a "non-network" pharmacy is used, medications may have to be paid for upfront. Federal regulations do not allow faxed prescriptions for controlled substances, including narcotics. In such an instance, people will need to obtain authorization and visit a local urgent care center or emergency room to obtain a prescription. Expect to be given a very limited supply in these circumstances.
• Emergencies -- An emergency is a serious medical condition that could result in the loss of life, limb or eyesight. If experiencing an emergency, call 911 or visit the nearest hospital emergency room. Emergency care does not require prior authorization before treatment. If follow-up or specialty treatment resulting from an emergency room visit is needed, contact the PCM for an authorization.
• Out of Area Urgent Care -- For urgent care while traveling, call the Nurse Advice Line at (800) 874-2273 and choose option 1 to speak to a registered nurse who can provide medical advice and, if necessary, authorize urgent care at a local clinic. Failure to obtain an authorization prior to receiving care will cause TRICARE to deny payment for the visit and will result in being billed directly for services.
• Non-Emergency Care for Active Duty Service Members -- Patients must receive all non-emergency care at a military treatment facility if one is available.
If an MTF is not available or unable to provide an appointment, beneficiaries must obtain prior authorization from their PCM or from the Nurse Advice Line before receiving non-emergency care.
For further information and assistance while traveling call Kenner Army Health Clinic Patient Appointment Line at 1-866-LEE-KAHC or DEERS to confirm eligibility.