Getting Medical Treatment After an Accident as an Active Duty Military Member
Active duty service personnel frequently experience more challenges after a car accident than civilians. One of these challenges involves accessing medical treatment covered by your TRICARE medical insurance.
If you’ve been injured in a car accident, getting to a military hospital or TRICARE-approved provider for treatment may be complicated or even out of the question, depending on your injury’s severity. Active duty service members are entitled to coverage for emergency treatment, even at out-of-network providers. If you are in a car accident and need immediate medical help, always go to your nearest emergency room for treatment, regardless of whether it is a TRICARE-approved provider. You do not need a referral to access emergency care.
All active duty military personnel must enroll in TRICARE Prime medical insurance. If you seek emergency care at a provider that TRICARE Prime does not cover, contact your TRICARE primary care manager within 24 hours or the next business day after receiving treatment. You may additionally need to submit a claim for reimbursement for out-of-network services.
Urgent care differs from emergency room care, and urgent care facilities are subject to different TRICARE restrictions. If you are an active duty service member, you need a referral from a TRICARE provider to access out-of-network urgent care. Therefore, go to an ER if you need immediate emergency care. For urgent care needs, contact TRICARE’s Nurse Advice Line.
Some active duty personnel may use non-TRICARE health insurance if eligible under DoD and Service regulations. If this applies to you, remember that TRICARE will never supplement other health insurance as a second payer. You will be responsible for all associated costs not covered by your health insurance. For questions about other health insurance, contact your branch’s TRICARE Service Personnel.
Ask The Car Crash Experts
-John Cooper, Personal Injury Lawyer
“The issues surrounding car wrecks or motorcycle wrecks with injuries where the person got hurt is in the U.S. Armed Forces are part of what I do day-in-day-out. I am very familiar having practiced in this community with some of the Army, Navy and Marine folks as my clients that I know these rules like the back of my hand. If you were injured in a car wreck or any other kind of personal injury that is off base and doesn’t arise out of your service you should get a civilian attorney who’s familiar with how the system works to make sure that you get the medical care that you need, that you maximize the recovery that you get in your own pocket, and that you comply with all rules and regulations for paying back the government whatever it’s entitled to get out of your case. If you are in the military and are hurt in an accident due to no fault of your own we can help.“
What If I Receive a Medical Bill While On Active Duty?
For active duty personnel, TRICARE Prime insurance covers all medically necessary procedures. However, when working with non-military providers, errors or miscommunications can occasionally occur when filing claims with TRICARE. Sometimes, you may receive a medical bill from a TRICARE-approved facility because specialists or individual providers do not accept TRICARE. These situations may generate medical bills in your name that TRICARE has not yet covered.
Does TRICARE Cover Medical Bills from Accidents?
If you were injured in a car accident or another incident caused by someone’s negligence and sought medical care, TRICARE typically covers all emergency medical bills, even from out-of-network providers. Our team is knowledgeable about TRICARE and is here to support our local military community.
Medical Debt and Medical Bill Collections Can Impact Your Military Career
Even though TRICARE Prime coverage is fairly comprehensive, medical debt still impacts military service members. Medical debt can affect civilian financial markers, such as your credit score, and hurt your military career.
If you’ve contacted TRICARE and have been unable to resolve the issue, reach out to your base’s Judge Advocate General office to see if they can assist.
Ask The Car Crash Experts
-John Cooper, Personal Injury Lawyer
“Rather as a personal injury attorney, I write to Naval Legal Services or the appropriate personnel with the government and get a kind of a bill called a Statement of Value which shows how much the government would seek to be paid back for the medical treatment provided from the at fault driver and their insurance company if there’s a successful recovery related to the car wreck which injured the military personnel. This statement of value is basically taken and used instead of a regular civilian bill to present to State Farm, GEICO, or Allstate just like a regular emergency room or surgeon’s bills would be outside of the military. The service member does not have to pay back the government for the Statement of Value and the lien of the government unless there is a successful recovery from the insurance company or person who caused the injury. If there were no claim or if the claim didn’t result in money for the service member then the government would not have to be paid back.“
Why Does TRICARE Have Liens on Car Accident and Personal Injury Settlements?
If you were injured in an accident and received compensation, TRICARE may have a claim to part of the settlement under the Federal Medical Recovery Act, or FMRA.
The statute provides that:
“[U]nder circumstances creating a tort liability upon some third person … [TRICARE] shall have a right to recover … the reasonable value of the care and treatment” that were provided to you and paid for by TRICARE.”
If a third person is liable for your injury, your TRICARE regional contractor will send you a copy of the Statement of Personal Injury–Possible Third Party Liability form, DD Form 2527. You must complete and return this form within 35 days of receiving it, or your accident-related claims will be denied.
The amount of the lien TRICARE is entitled to take from your personal injury settlement can vary. You may be able to negotiate the lien by contacting TRICARE directly. You also can call an experienced Virginia personal injury attorney to see if our office may assist with TRICARE lien negotiation where appropriate.
How To Contact TRICARE
For questions about coverage, medical debt, and other insurance issues, contact TRICARE directly through their secure online portal or by phone. If you’re stationed in Virginia, call TRICARE’s East Region office at 1-800-444-5445. If you need help with a specific issue, such as pharmacy care, and aren’t sure who to contact, you can use TRICARE’s Call Us Wizard to determine the correct phone number.
Why Trust Cooper Hurley Injury Lawyers When You're Stationed In Virginia
Cooper Hurley Injury Lawyers is a highly-regarded personal injury firm in the Norfolk, Virginia Beach and throughout Hampton Roads areas. Our partners were named to Coastal Virginia Magazine’s 2023 Top Lawyers of Coastal Virginia list in the personal injury field. We have offices near Joint Base Langley-Eustis in Newport News, Naval Station Norfolk, and Coast Guard Base Portsmouth, among other locations. We thank military personnel for their service, and we’re honored to help those who serve our country. Whether or not you’re military-affiliated, you’re welcome to call our office today at (757) 333-3333 or contact us online for a free legal consultation.
