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How to Find TRICARE Providers
You will need to know how to find Tricare providers if you are your family is enrolled in Tricare. Tricare is a health care program designed for uniformed service members, their families, and retirees. Tricare services military families around the world and has many different providers. If you need to find one, you may feel overwhelmed. However, the process of finding a Tricare provider near you can be quick and easy.
The Tricare provider portal on the Tricare website is the best place to search for providers. Through the portal, you can search for different types of providers, regardless of your Tricare plan. However, before you book an appointment, you will want to learn how provider options work, since doing so can affect both your out-of-pocket costs and claims filing. Therefore, to make sure that there are no surprises when you show up to your appointment, you should learn how to find Tricare providers.
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What is a TRICARE provider?
Before you can perform a Tricare provider search, you will need to know what Tricare providers are. According to program guidelines, an authorized network provider is defined as a business, hospital, pharmacy or individual that provides health care. To qualify, they must be licensed by a state or accredited by a national organization. Or, they must meet additional standards of the medical community. Also, Tricare must authorize and certify all of its providers, at a minimum, and the regional contractions must verify them. Afterward, they become Tricare-authorized providers.
What do TRICARE network providers do?
Tricare providers perform many different tasks for its members. These tasks include, but are not limited to, the following situations:
- Tricare network providers accept payments from Tricare as the full payment for any of the covered health care services that you obtain. However, it does not include out-of-pocket costs, when applicable.
- Network providers will file claims for you. If you are overseas, Tricare network providers only are required to submit claims for those who are in the Tricare Overseas Program (TOP), TOP Prime Remote, and active duty service members on temporary duty or leave.
- Tricare network provider will not ask you to sign documents that make you pay amounts that are more than your copayment or cost share. If this occurs, you will need to contact your regional contractor, or you can reach out to your Tricare Regional Office.
What are the different types of TRICARE-authorized providers?
According to program guidelines, there are two types of Tricare-authorized providers: Network and Non-Network providers. The two stateside regional contractors and the overseas contractor have together established networks of providers that accept payment from Tricare. You can choose from a variety of providers online or by phone.
To do so, you can contact the Tricare provider phone number or website if you have any questions. However, the phone number is different depending on which region you reside.
What are the benefits of seeing a TRICARE provider?
Now that you know the different types of Tricare doctors and providers, you may be wondering what the benefits of seeing a Tricare provider are.First, you will pay less out-of-pocket since Tricare will make the full payment for your covered health care services. Also, you will only be required to pay your cost share to the provider. Meaning, that your provider will collect the rest of the amount owed directly from Tricare.
What are the out-of-network providers?
If you have Tricare, you are not required to see a network provider. Therefore, you need to know the two types of non-network providers available, which are participating and nonparticipating providers.
As defined by the Tricare provider list, a participating provider accepts payment from Tricare as the full payment for the covered health care services that you obtain. Though out-of-pocket costs are not included, they will file a claim for you. If you are overseas, the provider may file claims on your behalf.
A nonparticipating provider does not provide either full payment coverage or claims filing for you. You may also need to pay the network provider first before you can file a claim for reimbursement.
For more information on Tricare providers, you can download our comprehensive guide.
What happens if I choose a provider that is a non-network provider?
You may be curious as to what will happen if you choose a non-Tricare physician or an out-of-network provider.
According to Tricare guidelines, while you can see a provider who is not Tricare-authorized, you will be responsible for paying the full cost of care since they do not have an agreement with the regional contractor. However, an exception may apply if you are faced with a life-threatening emergency.
How to Find a TRICARE Provider
You are now ready to search for Tricare locations now that you know that you must find a provider for the type of service that you need.
First, you will need to determine which region applies to you, since regional contractors establish provider networks in each region.
According to Tricare, there are two regions: The East Region Network Providers and the West Region Network Providers. However, there is also an overseas region. The most comfortable and most convenient way for you to find providers in your region is online through the Tricare website. You can also call the phone number for your region.
How to Book an Appointment with a TRICARE-authorized Provider
The quickest way to book an appointment with a Tricare doctor is through the Tricare website. When scheduling an appointment, you must know that the rules are based on which Tricare plan you have. Also, active duty service members have specific rules in which they must abide by. You can also click on your plan for more details.
Find out everything you need to know about how to book an appointment with a Tricare provider by downloading our free informative guide.