If a beneficiary visits a non-network participating provider, what payment method do they typically follow?

When a beneficiary visits a non-network participating provider, the typical payment method involves the provider accepting the TRICARE-allowable charge as payment in full. This means that the provider has agreed to accept the TRICARE reimbursement rate, which is determined based on various factors, including the type of service provided and the geographic area where the service is rendered.

By accepting the TRICARE-allowable charge, the provider acknowledges that they will not bill the patient for any additional excess amount beyond what TRICARE deems acceptable for that service. This arrangement provides a level of financial predictability for beneficiaries, as it limits out-of-pocket costs to what is covered under the TRICARE program.

In contrast, other payment methods mentioned, such as charging the full amount without TRICARE involvement or requiring additional payment beyond the allowable charge, would place a greater financial burden on beneficiaries. These alternatives do not align with the agreement that non-network participating providers make when they opt to accept TRICARE payments. The acceptance of the TRICARE-allowable charge helps ensure that beneficiaries have access to care without facing unexpected costs.