How do I appeal a TRICARE decision?
Quick Answer
Appeal denied claims or coverage decisions within 90 days by submitting a written appeal with supporting documentation to your regional contractor.
Related Video
Key Takeaways
- File within 90 days
- Multiple appeal levels exist
- Include supporting documentation
- Expedited review for urgent cases
Detailed Answer
You have the right to appeal decisions about coverage, claims, or referrals.
What Can Be Appealed
- Denied claims
- Authorization denials
- Coverage determinations
- Amount paid on claims
- Provider participation decisions
Appeal Levels
- Initial appeal (reconsideration)
- Formal appeal (if initial denied)
- Independent external review
- Federal court (after exhausting appeals)
How to File Initial Appeal
- Submit within 90 days of decision
- Write a letter explaining disagreement
- Include supporting documentation
- Medical records if applicable
- Send to regional contractor
What to Include
- Your contact information
- Claim or authorization number
- Date of service
- Reason for appeal
- Supporting evidence
- Provider statements if available
Timeline
- Decision within 60 days
- Expedited review for urgent cases
- Keep copies of everything
Related TRICARE Terms
Related Questions
How do I file a TRICARE claim?
Network providers file claims for you. For non-network providers or overseas care, submit DD Form 2642 with itemized bills to your regional contractor.
What is an Explanation of Benefits (EOB)?
An EOB is a statement from TRICARE showing services billed, amounts TRICARE paid, and any amount you owe. It is not a bill.
What do most military families add to their TRICARE coverage?
Supplemental health insurance is the most common addition — it covers dental, vision, and out-of-pocket costs that TRICARE leaves uncovered. Life insurance and a legal will are also highly recommended.
See What's AvailableShare this page
Was this FAQ helpful?
Need personalized help with this?
Most military families leave benefits on the table. Our free 2-minute coverage check identifies gaps, finds potential savings, and gives you personalized recommendations.
Check My Coverage