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Got TRICARE BILLS? (Article 5)
Follow These Simple Tips on What to Do
More often than not, TRICARE Prime beneficiaries receive care and have their claims paid without ever seeing a bill from the provider, even when the provider is part of the TRICARE network of civilian providers. The billing process is usually seamless to you because TRICARE providers work directly with your regional contractor’s claims processor to submit claims and handle the billing paperwork on your behalf. On the rare occasion that you do receive a bill from your provider, what should you do?

Call Your Provider
The solution is often as simple as calling your provider to make sure that your claims are being filed under the sponsor’s Social Security number. (TRICARE-eligible former spouses should make sure claims are filed under their own SSN.) While on the phone with your provider, also verify that your other personal information is correct in their records system.

Call Your Regional Contractor
Next, you can call Humana Military at 1-800-444-5445. Make sure you have the billing statements, your provider’s phone number, your sponsor’s Social Security number, and any other information relevant to the bill when you call.

Still Need Answers?
You can call or visit a beneficiary counseling and assistance coordinator (BCAC), who is located at the nearest military base. Make sure you have information related to your bill when contacting a BCAC, as well. The BCAC can serve as an agent between you, the claims processor, and your provider, making it easier for you to redirect the bill to the appropriate party. You can locate a BCAC in your area via the online directory at www.tricare.osd.mil/bcac.

Don’t Just Ignore the Bill!
No matter what, never ignore billing statements from your provider because overdue bills eventually may be sent to a collection agency. Billing statements that come to you from the provider or from TRICARE need to be handled promptly.
Make phone calls until the issue is resolved, starting with your provider, then Humana Military, then a BCAC. It’s that simple to avoid overdue bills that could, in turn, reflect poorly on your credit report.
 
 
A Closer Look Learn TRICARE's Policy on Balance Billing. It'll Save You Cash (Article 6)
As a TRICARE Prime beneficiary, you need to have a clear understanding of your financial responsibilities. The following information will assist you in knowing how much a provider can charge you.

Network providers agree with TRICARE to accept a negotiated rate, based on the TRICARE allowable charge, for their services. Non-network participating providers also consent to the TRICARE allowable charge when they agree to treat you.

If the cost of treatment is higher than the allowable charge and the provider sends you a bill to cover the remaining cost, that is known as balance billing. Network and non-network participating providers are prohibited from balance billing TRICARE beneficiaries.

When you receive care from these providers, the only amounts that TRICARE Prime beneficiaries may be responsible for paying are deductibles, copayments or cost-shares. One exception is when you request medical services that are not covered by TRICARE (e.g., chiropractic services). In those cases, you agree to pay for those services by signing a waiver of non-covered services.

If you choose to seek care from a non-network, non-participating provider, you may have to pay additional charges of up to 15 percent over the TRICARE allowable charge. For example, if the TRICARE allowable charge is $100, a non-network nonparticipating provider may charge $115. You will be required to pay the additional $15 over the allowable charge, plus your normal deductible, copayment or cost-share. Non-network non-participating providers may also ask you to pay all costs for care at the time of service, and you will need to submit a claim for reimbursement.

For each visit you make to a doctor, you will receive a TRICARE explanation of benefits (EOB) statement in the mail from Humana Military. The EOB tells you exactly what you are required to pay (beneficiary liability), if anything.
If you receive a bill from a network or non-network participating provider for any amounts in excess of what the EOB says you owe—especially if it’s for the balance of a treatment covered by TRICARE—call Humana Military immediately at
1-800-444-5445.
 
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Last Reviewed:  December 4, 2007