What Is a TRICARE Non-Network Provider? Quick Guide | TRICARE.com

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## Quick answer A non-network provider is a doctor, hospital, or specialist who has not signed a formal agreement with TRICARE’s regional contractors (Humana Military or TriWest). While they are authorized to treat TRICARE beneficiaries, they typically cost more out-of-pocket and may require you to file your own claims.

Details

In the TRICARE system, non-network providers fall into two distinct categories: **participating** and **non-participating**. Understanding the difference is critical to avoiding "balance billing," where you are charged the difference between the provider's bill and what TRICARE pays.

### 1. Non-Network Participating Providers These providers do not have a permanent contract with TRICARE, but they agree to "participate" on a case-by-case basis. * **Payment:** They agree to accept the TRICARE-allowable charge as payment in full. * **Claims:** They usually file the claim for you. * **Cost:** You are only responsible for your plan's standard cost-shares and deductibles.

### 2. Non-Network Non-Participating Providers These providers do not have a contract and do not agree to accept the TRICARE-allowable charge. * **Balance Billing:** They may charge up to 15% above the TRICARE-allowable amount. You are responsible for this extra 15% in addition to your normal cost-shares. * **Claims:** You will likely have to pay the full bill upfront and file a claim yourself to be reimbursed by TRICARE. * **Example (2026 Rates):** If the TRICARE-allowable charge for a visit is $100, but a non-participating provider charges $115, you pay the $15 difference plus your plan’s percentage of the $100.

### Plan Impact and "Point of Service" * **TRICARE Prime:** If you use a non-network provider without a referral from your Primary Care Manager (PCM), you will likely be charged under the **Point of Service (POS) option**. For 2026, POS charges include a $300 deductible for individuals (or $600 for families) and a 50% cost-share of the allowable charge. * **TRICARE Select:** This plan offers the most flexibility to see non-network providers. However, using network providers will always result in lower out-of-pocket costs. * **Active Duty Service Members (ADSMs):** ADSMs generally *cannot* use non-network providers without a specific authorization from their PCM and the regional contractor. Using one without approval may result in the member paying the full bill out of pocket.

### How to Tell the Difference Before booking an appointment, ask two specific questions: 1. "Are you a TRICARE-authorized provider?" (If no, TRICARE pays $0). 2. "Do you participate in TRICARE or accept TRICARE allowable charges?" (If no, expect to pay the 15% surcharge).

## Who this affects * **TRICARE Select Beneficiaries:** Retirees and family members who choose to see specialists outside the network. * **TRICARE Prime Beneficiaries:** Those who bypass their PCM for care and trigger the Point of Service option. * **TRICARE Reserve Select (TRS) & TRICARE Retired Reserve (TRR):** Members who often live in remote areas where network coverage is sparse. * **TRICARE For Life (TFL) Beneficiaries:** When seeing providers who do not accept Medicare or TRICARE.

## Sources * **TRICARE.mil:** [Provider Types](https://www.tricare.mil/Providers/Types) * **Humana Military (East Region):** [Find a Provider](https://www.humanamilitary.com/beneficiary/find-care) * **TriWest Healthcare Alliance (West Region):** [Provider Directory](https://www.triwest.com/en/beneficiary/) * **Defense Health Agency:** [Cost Terms and Definitions](https://www.tricare.mil/Costs/Cost-Terms)