What is the allowable charge under TRICARE?

The allowable charge under TRICARE refers to the maximum amount that TRICARE will reimburse for covered services. This amount is determined by TRICARE’s payment rates and is essential for both providers and beneficiaries to understand the financial aspects of healthcare services covered by TRICARE.

When a beneficiary receives care, the provider bills for the services rendered, but TRICARE has established allowable charges that dictate how much of that bill will be accepted and paid. If the billed amount exceeds this allowable charge, the beneficiary may be responsible for paying the difference unless they have additional insurance that covers the gap.

Understanding this concept helps beneficiaries know what to expect in terms of coverage and financial responsibility when accessing healthcare services through TRICARE. This knowledge is crucial for effective healthcare planning and avoiding unexpected costs.