Balance Billing

Balance billing occurs when a non-network provider charges you for the difference between the amount they billed and the TRICARE-allowable charge. Network providers agree to accept TRICARE's allowable charge as full payment and cannot balance bill, making them the more cost-effective choice.

How balance billing works: • A non-network provider charges $500 for a service • TRICARE's allowable charge for that service is $400 • The provider can bill you up to 15% above the allowable charge ($460) • You pay your cost-share (based on $400) PLUS the balance billing amount ($60)

Protection against balance billing: • Network providers: Cannot balance bill; accept allowable charge as full payment • Non-network providers: Can charge up to 15% above the TRICARE-allowable charge • Participating providers: May voluntarily accept TRICARE rates even if not in network

The best way to avoid balance billing is to use TRICARE network providers whenever possible. If you must use a non-network provider, ask upfront about their charges relative to TRICARE's allowable amount so you can anticipate your total costs.