What is a non-network provider in TRICARE?

A non-network provider in TRICARE is a healthcare provider who is authorized to treat TRICARE beneficiaries but does not have a contract with the regional TRICARE contractor. While TRICARE will still cover services from non-network providers (as long as the provider is TRICARE-authorized), beneficiaries face higher out-of-pocket costs and additional responsibilities. Non-network providers may charge up to 15% above the TRICARE-allowable amount, and the beneficiary is responsible for this excess charge. Non-network providers are not required to file claims on the beneficiary's behalf, so the beneficiary may need to pay upfront and submit their own claim for reimbursement. Cost-shares for non-network care are higher than for network care under TRICARE Select. Under TRICARE Prime, seeing a non-network provider without a referral results in point-of-service charges, which can be significantly expensive. Before seeing a non-network provider, beneficiaries should verify the provider is TRICARE-authorized, understand the potential additional costs, and consider whether a network provider is available for the needed service.