Let’s say you’re going to a doctor’s office or hospital. Your TRICARE insurance should cover it, but will you have to pay anything upfront and request reimbursement? It depends on the situation. Questions and answers regarding the most common treatment scenarios are below.
What if I have TRICARE Prime?
TRICARE Prime is a managed care option. It is similar to an HMO. Your provider will generally file claims for you. You most likely will not have to pay upfront.
What if I have TRICARE Select?
TRICARE Select is a self-managed, fee-for-service option that uses network and non-network providers. If you visit a network provider, you should not have to worry about filing a claim as the provider will handle this. However, if you visit a non-network provider, you may need to pay for services upfront and file a claim for reimbursement.
What if I have TRICARE and Medicare?
If you are enrolled in both TRICARE for Life and Medicare, Medicare is your primary payer and will handle claims first. You may need to file a claim if you go to a provider who does not participate in Medicare.
What if I have TRICARE Supplement?
You may need to file a claim if you see a non-participating provider. Because your main TRICARE plan pays first and TRICARE Supplement pays second, you should send your claim to your main TRICARE plan (TRICARE Select or TRICARE Prime) first. After this claim has been processed and you receive an Explanation of Benefits (EOB), you can submit this information to your TRICARE Supplement provider along with the provider’s bill and a claim form.
What if I go to a pharmacy for prescription drugs?
If you go to a network pharmacy, you should not have to worry about filing a claim. However, if you go to a non-network pharmacy, you may have to pay the costs yourself first and then file a claim to get your money back, just as with medical services.
What if I am not in the United States?
If you receive care outside the United States, you may need to pay upfront and file your own claim to get reimbursement. This process is somewhat different from the process for filing claims for care received in the United States.
How can I file a claim?
If TRICARE is your primary insurance and you received care in the United States, you can file a claim by submitting a medical claim form (DD Form 2642) and a copy of the provider’s bill. Mail this information to the claims filing address for your region.
If you received care outside the United States, you can file a claim online or with your overseas claims processor. You will need to include proof of payment with your claim.
Is there anything else I should know?
You should file your claim as soon as possible. Claims for care received in the United States or United States territories must be filed within one year of receiving care, and claims for care received outside the United States must be filed within three years of receiving care.
Be sure to include all requested information as omissions could lead to your claim being delayed or denied. You can file an appeal if you think your claim was denied when it shouldn’t have been. If you have any questions or problems, you can contact your regional contractor.
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