How to Use TRICARE Out of Region

Tricare is the U.S. Military healthcare system that serves active duty members and their families, as well as National Guard and Reserve members and retirees. It is an insurance program that allows participants to access civilian healthcare providers, as well as military hospitals. Those who choose to seek civilian medical treatment may want to visit a non-network provider. This is someone who is authorized to treat Tricare patients but does not have a contractual agreement to accept a negotiated rate of pay from them. Participants often choose to use non-network providers, because they prefer to stay with the doctor they know, or because network providers are not available at their location.

Instructions

• 1

  Contact Tricare to see if your healthcare provider is authorized. Tricare will not make payments to someone who is not authorized. The burden of payment will be entirely yours. If your provider is authorized, you will still incur some cost, but not as much.

• 2

  Check with your provider to see is he is participating or not. A participating provider has agreed to charge the Tricare rate and to file your claims, even if he is not under contract. A non-participating provider may charge more, and you will be responsible for paying him.

• 3

  File a claim with Tricare. If your provider is non-participating, you may have to pay him the entire amount and then file a claim yourself, requesting reimbursement from Tricare. Even if Tricare does pay the claim, you should be prepared to assume a larger share of the cost.

  Whether the provider is participating or non-participating, the enrolled member is considered to be using the "standard option" when he visits a non-network provider. That means he is expected to pay a deductible, as well as a percentage of the cost.