Healthcare at a high cost: Stand-alone emergency rooms not TRICARE authorized

U.S. AIR FORCE ACADEMY, Colo. -- TRICARE beneficiaries need to pay close attention to their facility of choice when en route for emergency care.

Despite newer and closer emergency rooms surfacing throughout Colorado Springs, not all are affiliated with a hospital, therefore could increase a patient's ER bill by thousands of dollars.

"Emergency centers popping up in the area, such as 'First Choice, Emergency Room' are currently not TRICARE authorized," said Lt. Col. Paul Hoerner, 10th Medical Support Squadron commander. "If a provider, such as a free-standing ER, is not authorized, then TRICARE is prohibited from paying its facility fees."

According to Hoerner, TRICARE defines an emergency department as an organized, hospital-based facility available 24 hours a day, providing emergency services to patients who need immediate medical attention.

"Emergency departments affiliated with a hospital are most likely TRICARE-authorized providers," he said. "Beneficiaries who seek care at a free-standing ER need to ask if the facility is affiliated with a hospital-based emergency department. If it isn't, the beneficiary will need to make a decision about getting care elsewhere or being responsible for the charges."

Nationally, the number of stand-alone ERs doubled to more than 400 since 2009, according to data from the American Hospital Association.

"Stand-alone emergency centers are a relatively new type of medical facility," Hoerner said. "Patients may not realize that there is a difference in TRICARE coverage between a traditional emergency room and a stand-alone emergency center."

Beneficiaries can confirm if a provider is TRICARE authorized by calling their regional contractor. Contact information for regional contractors is available at www.tricare.mil/contactus. All TRICARE network providers are also searchable at www.tricare.mil/findaprovider.

"Patients should also contact TRICARE about receiving an authorization before going to an urgent care facility," Hoerner said. "Make sure you follow your plan's rules for getting urgent care."

For more information on TRICARE emergency care, visit www.tricare.mil/emergency.