Would the symptoms of pneumonia be considered an emergency for TRICARE?

Question

I have been sick for close to two months (while in bootcamp). I'm on leave now and my illness is now in my lungs. I have taken tons of cold meds and ibuprofen, but over the last couple days it has become hard to breathe. I cough a lot and my chest hurts. The nearest TRICARE facility is over 100 miles away. I just want to know if I were to go to the local ER for shortness of breath, would I end up getting billed because it's not a big emergency like getting stabbed in the chest?

Answer 1

First of all you are active duty military (right?). Go to the nearest ER and show them your Military ID.

Under all TRICARE programs, no referrals or authorizations are required for TRICARE beneficiaries receiving emergency care in or out of their TRICARE region. The bill to Tricare will list your DRG (Disease Related Grouping) so you won't have to worry about any of that. Most ERs bill TRICARE directly, but if you are concerned, you can contact the hospital prior to going.

Yes you might get a bill. Either because the ER doesn't bill TRICARE directly or in error. So if you do get a bill take it to the patient admin section of your next command when you arrive there.

Answer 2

You can't worry about the cost. Pneumonia is very serious. I had the onset of it with the coughing and having a hard time to breathe. When I went to the doctor I only had the onset. I was put on antibiotics and it cleared right up. You can do serious damage to your lungs if it is not taking care of promptly. It is not just a cold. It is an infection that is putting fluid on your lungs. The bill can be worked out later. My insurance makes me pay more if I am not admitted during after an ER visit. Go to the ER get some meds and you will be feeling better soon.

Answer 3

You're active duty. A life, limb or sight threatening condition is an emergency. So, is any condition which compromises your airway. So, go to the nearest civilian hospital and get treated. The bills will be adjudicated for payment under the Non-Federal Medical Claims Program. It's different from Tri-Care. There's no co-pay. Have the hospital send the bills to the Chief of Patient Affairs or Chief of Patient Administration at the military hospital that supports your next duty station.

Answer 4

GO TO THE ER RIGHT AWAY, DON'T MESS WITH THIS!!!!!
Ok not going to yell again, Your in the military, tricare will pay for this.
I had pneumonia back in Jan, Im only a military spouse and have tricare standard, but let me tell you, i am sooooo glad i had that! I was in the hospital for 10 days because i was that sick, before tricare paid, my bill was $18,000! then tricare paid and my final bill that i owed the hospital was $114.00 big difference huh?
BTW this was at a local hospital. Go now before it gets worse. trust me on this one, im not the same since i got pneumonia, i have to have a nebulizer, i think because i waited to long to go into the ER, i thought i could fix it myself, cold med's etc....It just got worst each day.
So trust me go today.

Answer 5

You really should make an appointment with your doctor as pneumonia can kill you if left untreated. I just got out of the hospital after having pneumonia. The main symptoms are: A dry cough with green or yellow mucus, fever with shaking chills, sharp or stabbing chest pain worsened by deep breathing or coughing, rapid, shallow breathing, shortness of breath, headache, sweating and clammy skin, loss of appetite, excessive fatigue, and body aches. Pneumonia is often a complication of a pre-existing condition/infection and triggered when a patient's defense system is weakened, most often by a simple viral upper respiratory tract infection or a case of influenza, especially in the elderly. Pneumonia affects the lungs in different ways. Lobar pneumonia affects a lobe of the lungs, and bronchial pneumonia can affect patches throughout both lungs. Pneumonia is typically treated with antibiotics, plenty of water, and bed rest. A vaccine is available for bacterial pneumonia. The pneumococcal vaccine protects against 23 types of pneumococcal bacteria populations and is effective in approximately 80 percent of healthy adults. Influenza vaccination is also recommended since pneumonia often occurs as a complication of the flu.

Answer 6

Go to the ER.

As an active duty military person it is highly unlikely they will stick you with the bill.


Next time, go to your primary care provider and do not "sit" on it for two months.

K?

Answer 7

If you have tricare, you will not be billed for emergency care. get to the hospital before you are taking by ambulance

Answer 8

Go to the ER!! If you have pneumonia, your lungs could fill with fluid and you could die. GO...NOW!!! Worry about the money later. Doesn't the military pay for your medical bills?

Answer 9

If you are on active duty your ID card is your tricare card. It will be paid for, but you may have a copay, but so what, is your life worth it?