Urgent or Emergency? Combating the "Deadly Quartet" of Health Problems Fighting Health Care Fraud and Abuse The Truth About When To Get Your Pap Test

1. S P R I N G 2 013 A P U B L I C AT I O N F O R T R I C A R E ® P R I M E B E N E F I C I A R I E S
The Doctor is in ... • Difficulty breathing or shortness of breath
Urgent or Emergency? • Sudden dizziness, weakness or changes in vision
• Severe or persistent vomiting or diarrhea
W. Bryan Gamble, M.D., FACS • Changes in mental status, such as confusion
Brigadier General, US Army You do not need authorization for emergency care before
Deputy Director, TRICARE Management Activity receiving treatment. However, if you’re enrolled in a
TRICARE Prime plan you must contact your primary care
I f you or your child gets sick or
injured, your first instinct may be
to go to the emergency room (ER)
manager (PCM) or regional contractor within 24 hours or
the next business day after you receive emergency care.
right away or call 911. These are good Urgent care is when an illness or injury is serious enough
instincts in an emergency, but many to seek health care right away, but not so severe as to
people use the ER when it is not an require emergency room care. Some examples include
actual emergency. This contributes earache, toothache, joint sprain, muscle pull or urinary
to long ER wait times, high costs tract infection. You can get urgent care from your PCM
and unnecessary medical care. or from an urgent care center if your PCM is inaccessible.
Sometimes, using an urgent care clinic may be your best Urgent care can be quicker, with a lower cost and better
choice and can help responsibly preserve the TRICARE results, compared to a crowded ER that may require
benefit for future generations of military families. unnecessary tests or hospital stays.
It can be difficult to know whether an illness or injury is Many urgent care centers are open after normal business
really an emergency, but the judgment is yours to make. hours and on the weekend, so you can go at a time that fits
If the condition is obviously life threatening or causing with your schedule, or when a health problem warrants.
severe pain and distress, then the need for an ER is clear. If you have TRICARE Prime, you need to get prior
TRICARE views an emergency as a medical, maternity authorization from your PCM or your regional contractor
or psychiatric condition you believe could threaten your to avoid additional costs for visiting an urgent care center.
life, limb or sight without immediate medical attention. If you are traveling, you need to contact your home region
Other emergencies include severe, painful symptoms for authorization. You can find contact information for
requiring immediate attention, or when a person may your regional contractor at www.tricare.mil/contacts.
be an immediate risk to self or others.
According to the Urgent Care Association of America,
If you or a family member experience any of the following 57 percent of visits to an urgent care facility have a wait
symptoms, go to the ER immediately: time of 15 minutes or less. By comparison, the Centers for
• Chest pain or pressure … continued on page 3
• Uncontrolled bleeding
• Sudden or severe pain Inside This Issue ...
• Coughing or vomiting blood • Combating the “Deadly Quartet” of Health Problems
• Fighting Health Care Fraud and Abuse
• The Truth about When To Get Your Pap Test
An Important Note About TRICARE Program Information: At the time of printing, this information is current. It is important to remember
that TRICARE policies and benefits are governed by public law and federal regulations. Changes to TRICARE programs are continually made
as public law and/or federal regulations are amended. Military treatment facility guidelines and policies may be different than those outlined
in this publication. For the most recent information, contact your TRICARE regional contractor, TRICARE Service Center, or local military
treatment facility.

2. Combating the “Deadly Quartet” of Health Problems
T he “deadly quartet” refers to the four chronic
conditions—high blood pressure, high cholesterol,
obesity and diabetes—that are particularly harmful to your
Avoid the “Deadly Quartet”
Some simple lifestyle changes can help you prevent—and
health. These conditions contribute to the leading causes of even reverse—these conditions. Here are some changes
death and disability in men and women in the United States. to consider:
• Eat more fruits and vegetables
High Blood Pressure • Consume smaller portions (for example, a single
serving of meat is about the size of your palm)
If left untreated, high blood pressure can cause a stroke,
heart disease, kidney failure or other problems. Strokes may • Eat leaner meats, such as chicken and fish
lead to many other problems, including being paralyzed. • Increase regular physical activity (just 30 minutes of
Heart disease is the number-one killer of men and women walking a day four or five days per week can make
in the United States. High blood pressure often has no a positive difference)
symptoms, so you should have yours checked yearly at your
routine doctor visits. For more tips on living a healthy life, visit
TriWest.com/HealthyLiving or www.tricare.mil/getfit. n
High Cholesterol 1. http://www.cdc.gov/obesity/childhood/
High cholesterol, which may not present any symptoms,
increases plaque buildup in your arteries. This buildup can
cause a heart attack; it is also a major risk factor for heart
disease. TRICARE covers your cholesterol tests at least once
every five years beginning at age 20. People with diabetes,
regardless of age, should have their cholesterol checked at
least once each year.
Obesity
Obesity is caused primarily by poor eating habits and lack
of exercise. Obesity will strain your heart, joints and bones,
and can cause other diseases common in adults, such as
type 2 diabetes.
Obesity has become widespread in children, too. According
to the Centers for Disease Control and Prevention, obesity
now affects 17 percent of all U.S. kids and teenagers.1
Childhood obesity often carries into adulthood, causing high
blood pressure, arthritis, sleep apnea and low self-esteem,
among other problems.
Diabetes
Diabetes is a disease in which your blood glucose levels
are above normal and your body either does not make
enough insulin or cannot process it properly. A major cause
of type 2 diabetes is obesity. Diabetes is a major risk factor
for heart disease and is the leading cause of kidney failure
and new cases of blindness.
2 TriWest.com Spring 2013

3. The Doctor is in ...
Urgent or Emergency?
… continued from page 1
Disease Control and Prevention reports only 22 percent of
visits to an emergency room have wait times of 15 minutes
or less.
Getting urgent care instead of visiting the ER can also save
money. ERs are required to run expensive diagnostic tests
that may not be necessary if your condition is less serious.
Being judicious with your health care spending can make
your household budget go further, and cost-efficient urgent
care will help protect your TRICARE benefit in these
uncertain financial times. Correction: “The Doctor is in” column that ran in the
It’s a good idea to be aware of nearby urgent care facilities Health Matters Winter 2012 newsletter was written by
in the TRICARE network, just as you would with the closest Barclay P. Butler, Ph.D. The article did not identify
Dr. Butler as the author and as Director, Department of
ER. To find an urgent care facility near you in the TRICARE
Defense/Department of Veterans Affairs Interagency
network, visit www.tricare.mil/findaprovider and select the
Program Office.
search tool for your regional contractor. n
Fighting Health Care Fraud and Abuse
H ealth care fraud and abuse cost American taxpayers
billions of dollars each year. TRICARE and TriWest
Healthcare Alliance (TriWest) are committed to ensuring
• If you notice any differences between the services reflected
on your EOB and the services you received, call the toll-
free number listed on the EOB.
you receive care from trustworthy providers and that
Differences do not always indicate fraud, but they can
taxpayer money is used appropriately.
indicate mistakes that may result in improper claims
reimbursement from TRICARE or cause your medical
What Are Fraud and Abuse? record to be incorrect.
Health care fraud is intentional deception or misrepresentation If you have any concerns about your medical record, you
that enables someone to obtain an unauthorized benefit or should follow up with your health care provider to ensure
payment. Health care abuse occurs when providers supply the services you received are reflected properly. To learn
services or products that are medically unnecessary or that more about how TRICARE and TriWest combat fraud
do not meet professional standards. You are an important and abuse, visit the TRICARE Fraud & Abuse website at
partner in the ongoing fight against fraud and abuse within www.tricare.mil/fraud or visit TriWest.com.
the TRICARE program.
To report fraud or abuse regarding the TRICARE Pharmacy
How You Can Help: Program, contact Express Scripts, Inc. at 1-800-332-5455,
ext. 367079, or by e-mail at fraudtip@express-scripts.com. n
• Always review the explanation of benefits (EOB) you
receive after health care services. The EOB should list the
services and supplies you received.
Spring 2013 1-888-TRIWEST 3

4. TRICARE
Generous coverage
Superior health care
TriWest Healthcare Alliance
P.O. Box 42049 Decisions are health
Phoenix, AZ 85080 driven, not insurance
driven
High satisfaction
with care
Low out-of-pocket costs
Easy access
“TRICARE” is a registered trademark of the TRICARE Management Activity. All rights reserved.
The Truth about When To Get Your Pap Test
A midst the recent media buzz debating when women
should get their Pap tests, you may be wondering when
exactly you should be going to the doctor. New guidelines
3. Clinical breast exam: A doctor will physically examine
your breasts for unusual bumps or growths, which could
indicate breast cancer. Think of the clinical breast exam
issued by the United States Preventive Services Task Force like your monthly self-examination, but by a professional
in March 2012 recommend that women should have a Pap who can detect abnormalities you cannot.
test to screen for cervical cancer every three years beginning
at age 21. But while you may only need a Pap test once every How Often Should I Visit the Doctor?
three years, you will need the other parts of your well-
Regardless of recommendations about how often you
woman exam every year.1
should get a Pap test, you should still visit your doctor for a
complete well-woman exam every year, so that you can get
What Happens During a Well-Woman Exam? a pelvic exam, breast exam and other screenings or care you
A complete well-woman exam includes three main parts: may need. TRICARE covers these well-woman exams at no
cost to you as long as you visit a civilian network provider or
1. Pelvic exam: During this exam, the doctor visually military treatment facility.
and manually checks your reproductive organs and
your general pelvic area for abnormalities. This includes For more tips on healthy living, visit TriWest.com’s Healthy
checking your ovaries and uterus. The pelvic exam is Living portal at TriWest.com/HealthyLiving. n
important because it can detect other signs of cancer 1. http://www.uspreventiveservicestaskforce.org/uspstf11/cervcancer/
besides cervical. cervcancerrs.htm#clinical
2. Pap test: This is the actual cervical cancer screening,
NE311BEW12123
where the doctor will remove cells from the surface of
your cervix to test for cancer.
4 Spring 2013