Non-Network Provider

A non-network provider is a healthcare provider (doctor, hospital, clinic, or other healthcare professional) who has not signed a contract with TRICARE or its regional managed care contractors. Using non-network providers generally results in higher out-of-pocket costs and additional administrative burden for the beneficiary.

Implications of using non-network providers: • Higher cost-shares (typically 5% more than network rates) • Potential balance billing up to 15% above the TRICARE-allowable charge • You may need to file your own claims • No guarantee the provider will accept TRICARE • Higher total out-of-pocket costs

Cost comparison example (TRICARE Select, retiree): • Network provider: 20% cost-share, no balance billing • Non-network provider: 25% cost-share PLUS up to 15% balance billing

When you might use non-network providers: • No network provider available for the needed specialty • Emergency care (emergency protections apply regardless of network status) • Living in an area with limited network options • Choosing to see a specific provider

To minimize costs, always try to use network providers. Use your regional contractor's provider directory to find in-network options before scheduling appointments.