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TRICARE offers comprehensive medical and behavioral health benefits to military and retired service members and their families. But like all health care plans, certain services are not covered benefits.

If a beneficiary promises to pay for a non-covered service, network providers must follow the proper procedure to ensure payment. Otherwise, the beneficiary is absolved of any liability under TRICARE’s hold harmless policy. There are two steps to ensure payment under the policy:
 

1. First, inform the beneficiary verbally, by phone or in person that the desired service or procedure is not covered. Document this process in your records.
    
2. Then, have the beneficiary sign a TRICARE-specific Request for Non-Covered Services Form before the service or procedure is rendered. Please note: A waiver signed after care is rendered as not valid.

This two-step procedure ensures that the beneficiary is “fully informed,” which is defined as being informed both verbally and in writing.

The Request for Non-Covered Services Form documents the specific treatment, date of service and billed amounts in advance of the service or procedure. This form specifies that the beneficiary will have to pay for services not covered by TRICARE, and it protects the network provider from having to pay for the cost of care. By signing the form, the beneficiary agrees in advance to be financially responsible for a specific non-covered service. A general waiver, like that signed by a patient when entering a hospital, for example, does not meet the requirement. 

The “Medical Coverage” chapter of the TRICARE Provider Handbook offers a listing of excluded and limited services under TRICARE.  You can also refer to the TRICARE Policy Manual on the TRICARE Web site for additional exclusion and limitation information.

In cases where you are unsure of TRICARE coverage, you and/or the beneficiary can file an authorization request with Humana Military. If denied, the provider and the beneficiary will receive a letter from the regional contractor that explains the denial and step-by-step appeal procedures. If all appeals are denied and the patient chooses to pay for a non-covered service, then the hold harmless policy and two-step process applies.

For more information, call Humana Military at 1-800-444-5445.
 

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• You receive information in a timely manner from Humana Military.
• You ensure that claims payments are sent to the correct address.
• You provide accurate information to beneficiaries who use the online Provider Directory to choose a new provider. Key information includes not only your phone number and address, but also whether you’re accepting new patients. 

Humana Military strives to keep its Web site as comprehensive as possible, including updating it every 24 hours. Some physicians, such as emergency room physicians and urgent care physicians, may not be available in the directory. Information is subject to change without notice.

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Last Reviewed:  February 13, 2007