TRICARE-allowable charges and balance billing: What you need to know
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Key Points:
- The TRICARE-allowable charge is the maximum amount TRICARE will pay for a service, and it determines your cost-share; balance billing occurs when providers bill you the difference between their charge and this allowable charge.
- Only nonparticipating providers—non-network providers who haven't agreed to accept the TRICARE-allowable charge as full payment—are allowed to balance bill, with a limit of 15% above the allowable charge in the U.S. and territories.
- Network providers accept negotiated rates as full payment, file claims on your behalf, and cannot require you to pay amounts beyond your copayment or cost-share, while nonparticipating providers may require upfront payment and you must file claims yourself.
- When using nonparticip
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