In TRICARE, when an enrollee is covered by multiple insurances, which determines the payment order?

Prepare for the TRICARE Fundamentals Course (TFC) Exam with flashcards and multiple choice questions, each with hints and explanations. Ensure success on your test!

In TRICARE, when an enrollee has coverage from multiple insurance plans, the payment order is determined by the specific plans involved. This means that the set rules and coordination of benefits established by the insurance plans dictate which insurer pays first and subsequent payment responsibilities.

Typically, one insurance will be designated as the primary insurer, responsible for paying the initial claims, while the other plans provide secondary coverage and may cover additional costs once the primary plan has processed the claim. The rules governing these arrangements can vary by plan, which is why the specific plans involved play such a crucial role in determining the correct order of payment.

The other factors mentioned, such as amounts billed by providers, the patient's personal preference regarding which insurance to use, or the specific health condition being treated, do not directly influence the payment order established by insurance coordination rules. Instead, these aspects might impact the overall healthcare experience or the insurer's payment amounts but do not dictate which insurance holds priority in payment responsibilities.

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