Medical care overseas can be confusing for U.S. Army Family members, and over the last few years, transformation efforts and the Global War on Terrorism have changed resources and processes for the U.S. Army Medical Activity Bavaria. The following information is an overview on how health clinics and health care in Bavaria operates.
Beginning in August, the new footprint of BMEDDAC will consist of seven health clinics supporting 40,000 patients. The health clinics are located in Bamberg, Grafenwoehr, Hohenfels, Illesheim, Katterbach, Schweinfurt, and Vilseck. The current health clinic in Wuerzburg will shut its doors the end of July with the closure of Leighton Barracks. The final move out of Wuerzburg will complete what began in fall 2007 with the closure of the U.S. Army Hospital Wuerzburg.
The clinics are out-patient primary care or ambulatory clinics and are capable of providing urgent care, routine care, and wellness examinations. Ambulatory care is defined as medical services that are provided as an out-patient. Services could include diagnosis, treatment, and rehabilitation. The health clinics do provide some special resources such as physical therapy, optometry, audiology, and behavioral health.
Resources are shared in the BMEDDAC footprint. When Soldiers are redeployed, providers and staff are often rerouted to the redeploying community to help the returning Soldiers during the reintegration period.

Patient Categories
There are three types of patients that receive care from the health clinics in Bavaria.
TRICARE Prime Overseas is a managed-care option that provides benefits to active duty service members, reserve-component members on active-duty orders, and their eligible command-sponsored family members stationed or living overseas. There are no enrollment fees, deductibles, cost-shares, or co-pays for authorized medical care at a U.S. health clinic or with German providers and hospitals. TRICARE Prime patients receive priority access at all BMEDDAC health clinics.
TRICARE Standard is available for retirees living overseas and active-duty family members who choose not to enroll in TRICARE Prime Overseas. Standard is a fee-for-service option that authorizes beneficiaries to seek care from any TRICARE-authorized provider, and the patient is responsible for annual deductible and cost-shares. There is no fee for enrollment.
TRICARE Standard patients may only use the BMEDDAC health clinics on a space-available basis and for limited immunizations, but Standard patients do not need authorization to see the host-nation provider of their choice. BMEDDAC recommends that TRICARE Standard patients establish a relationship with a German physician to ensure continuity of care.
TRICARE ECHO is the extended care option, a supplemental program that provides eligible active duty family members with an additional financial resource for an integrated set of services and supplies designed to assist in the disabling effects of the beneficiary's qualifying condition. Conditions include moderate or severe retardation, serious physical disability, or an extraordinary physical or psychological condition that the beneficiary is homebound.
Go to www.europe.tricare.osd.mil for more information.

Types of Care
Medical visits are broken out into categories: specialty, well, routine, urgent, and acute or emergency. Access standards are established for each category to ensure that you receive care in a timely manner.
Specialty care that is provided by the health clinics including physical therapy, optometry, audiology, and behavioral health. Specialty care that cannot be provided by the health clinic is referred to the physician provider network. The access standard is to be seen within one month from the date of your call for a specialty visit to the health clinic.
Well visits are services such as health screenings and examinations, often conducted at regular intervals, and are meant to keep you healthy or detect health problems in a timely manner. They include mammograms, cholesterol testing, immunizations, well-baby, colorectal cancer exams, blood pressure readings, and Pap smears. You should be seen within one month of your call for a well visit to the health clinic.
Routine care includes general office visits for the treatment of symptoms, chronic or acute illnesses, and diseases and follow-up care for an ongoing medical condition. Routine care also includes preventive care measures to keep you healthy. A routine visit standard of care means that you should be seen within one week for your condition.
Urgent care services are medically necessary services which are required for illness or injury that would not result in further disability or death if not treated immediately, but require professional attention and have the potential to develop such a threat if treatment is delayed longer than 24 hours.
Conditions that should receive urgent care include: sprains, scrapes, ear aches, severe headaches, rising fever, persistent vomiting or diarrhea - conditions that are serious but are not life threatening. You should be seen within one day once you have made the call to the health clinic.
Acute care or emergency services are provided for a sudden or unexpected medical or psychiatric condition, or the sudden worsening of a chronic condition that is threatening to life, limb, or sight and needs immediate medical treatment, or which has painful symptoms that need immediate relief to stop suffering.
Conditions that require emergency care include: loss of consciousness, shortness of breath, chest pain, uncontrolled bleeding, drug overdose, suicide attempt, poisoning, acute psychosis, and unexpected weakness. These conditions require immediate attention and a visit to the emergency room at a local German hospital.
The health clinics do not have their own emergency rooms, nor are they open 24 hours a day. In the case of an emergency, go to the nearest hospital. If you don't know the location of your closest hospital, contact your local health clinic well in advance of an emergency to find out and post the information in a handy location.
Emergency transportation can be provided by the German Red Cross. Patients can access the ambulance service by calling for translation through the Military Police or directly through the German Red Cross. Dispatchers will send the closest available ambulance to your location. A German Emergency Physician will often meet you to direct your care.
If you do have an emergency and need to go straight to the hospital instead of getting a referral, contact the TRICARE representative the next working day. You will need to report your emergency as soon as possible to ensure that TRICARE will cover all costs, and if you do not have TRICARE you can get started on your billing paperwork.

Preferred Provider Network
Due to the closure of the hospital and the ongoing need for specialty care, BMEDDAC health clinics routinely refer patients to the Preferred Provider Network in Bavaria.
The PPN is a network of German health care physicians who see our patients. They are general physicians as well as specialists in every field, such as OB/GYN, pediatrics, radiology, neurology, orthopedics, and oncology. Their medical qualifications are screened and we make periodic visits to their office or hospital.
TRICARE Prime patients are eligible to see physicians who are at the top of their field and often the head of their particular medical department. While the clinic or hospital staff may not speak English, most do and all physicians must speak English to be in our network.
BMEDDAC currently has 376 doctors in the PPN, and the number continues to grow. Outpatient, inpatient, and emergency care is provided by the 21 local hospitals in the communities surrounding the seven health clinics of the BMEDDAC footprint.
If the health clinic provider decides to refer you to care with the PPN, the provider will enter a consultation request to authorize care. You will then need to see the TRICARE advisor located in the clinic, who will schedule your appointment and provide you with directions and contact numbers for the PPN.
The TRICARE advisor will counsel you on benefits and give you the required forms for your appointment. If you can't make your appointment, contact the PPN and reschedule. You can reschedule directly without contacting TRICARE for another authorization.
Visits to the PPN are part of TRICARE Prime; and the PPN will submit the bill directly to TRICARE. If you happen to receive a bill, bring it in to the TRICARE advisor for assistance.
If your care requires you to spend time in a German hospital, TRICARE Prime will also cover your stay and the costs of your care. You will most likely have share a room; if you'd like a single room, it is not covered by TRICARE Prime and usually costs around 50 euro per day.

Patient Liaisons
Patient liaisons help smooth the way during a stay in the German hospital. Liaisons are fluent in German and English. They are well acquainted with local hospital staff and know the medical system procedures.
Expect a patient liaison to make contact with you daily, including weekends. On their first visit with you, they will provide a booklet with basic information on what to expect. They are also there when you are discharged to make sure you understand your instructions for care at home and that you have the necessary prescriptions.

Pharmacy
Each of the seven health clinics has a pharmacy. The pharmacies can fill prescriptions written the by providers at the health clinics. Prescriptions that are written by a German physician can be filled if the medication is part of the pharmacy's formulary and the prescription is written in the American format. For more formulary information and instructions to give your German doctor, stop by your health clinic's pharmacy.
If the German prescription is not part of the health clinic's formulary or not written in the American format, it must be filled by the German Apotheke. You will need to pay for your medication upfront, and then TRICARE will reimburse you. Prior to filling the prescription, contact the TRICARE service center to ensure the medication is covered. Reimbursement usually takes about four to six weeks to process.
Contact Us
If you have questions or concerns about your care, let us know. BMEDDAC is here to help you with you medical care. We need to hear your concerns in order to address them. Contact your health clinic commander, who will make an inquiry and respond to your questions. BMEDDAC strives to make care easy for patients, and we look forward to continued communication with you.

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Hospital tour cutline: Obstetrician Dr. Ines Erhardt answers questions for expectant parents during a tour of the maternity ward at Amberg's Klinikum St. Marien May 27. Tours are conducted in English on a rotating basis at the local German hospitals.