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Under a new Tricare pilot program, select users will soon be able to receive care at an urgent care clinic without a referral. According to Tricare's website, the pilot begins on May 23, 2016, and ends on May 23, 2019.
The three-year program was ordered by Congress as part of the 2016 National Defense Authorization Act. It's intended to allow nearly all Tricare users two urgent care visits per fiscal year without authorization from a provider. Once both visits have been used, beneficiaries will need a referral if they want to continue using an urgent care.
As it stands right now, beneficiaries can only be seen by referral or by their primary care manager for acute conditions. The program aims to fix an age-old problem where military families are using emergency room services when they are not able to get an appointment with their primary care doctor. Not requiring a referral will give urgent care centers a new audience to educate about their benefits—and potentially a new stream of patients to serve.
Amy Bushatz of Military.com reported, “Active-duty service members and activated Guard and Reserve members enrolled in Tricare Prime Remote and all other beneficiaries enrolled in Tricare Prime, Tricare Prime Remote or Tricare Young Adult, including retirees, will be allowed two non-authorized visits per year. Tricare Overseas Program users seeking care in the U.S. will be permitted unlimited urgent care visits without authorization, the policy state.”
The only way you don't qualify for the pilot is if you're an active duty service member or activated Guard/Reserve member enrolled in Tricare Prime. You also aren't eligible if you're enrolled in the US Family Health Plan or enrolled overseas.
When the National Military Family Association was asked about the new program, Karen Ruedisueli, deputy director of government relations for NMFA, said: “We don’t oppose a cap, but we believe a cap should’ve been higher.”
It will be interesting to see how much money the new initiative will help the system save on emergency room visits by allowing easier access to urgent cares facilities.