Avoid bills for urgent care services, understand the process

  • Published
  • By the 49th Medical Group
HOLLOMAN AIR FORCE BASE, N.M. --  If you decide to go directly to an urgent care center without calling the 49th MDG appointment line and first obtaining a referral, you may be responsible for a significant portion of the cost of your care.

Avoid these bills for urgent care services by understanding the process.

Here's how it works:

- For urgent care needs, beneficiaries must call the 49th Medical Group appointment line at 572-2778 to obtain an urgent care appointment. If no appointments are available at the 49th MDG, he/she may be referred to a local urgent care center, such as Alamogordo Urgent Care.

- When the beneficiary obtains a referral to an urgent care provider, the 49th MDG will notify TriWest of the referral within 24 hours or the next duty day. Once TriWest receives the referral notification, their claims department will seek to match up the referral with the claim based on the date of service.

- If a referral was not obtained or cannot be found, the beneficiary and the urgent care provider will receive an Explanation of Benefits statement indicating that the claim will be paid using the Point of Service option. Under the Point of Service option, the beneficiary will be responsible for paying the bill.

- If the beneficiary disagrees with the Point of Service option because he/she obtained a referral, the beneficiary may appeal the decision through the TRICARE Operations and Patient Administration Flight Section at the 49th MDG. If the appeal is denied, he/she remains responsible for paying the bill. However, if the appeal is sustained, the TOPA Flight staff will inform TriWest and the claim will be reprocessed for payment without the Point of Service charge.

In order to avoid having to pay for civilian medical services, we urge all of our beneficiaries to call the 49th MDG appointment line to obtain an urgent care referral prior to seeking urgent care treatment downtown.

Please call the TOPA Flight at 572-7700 with any questions about explanations of benefits or urgent care bills.