Non-Network Provider | TRICARE Glossary & Costs | TRICARE.com

*Note: TRICARE.com is an independent reference site and is not affiliated with the Department of Defense or the official TRICARE program. For official policy, visit TRICARE.mil.*

## Definition A non-network provider is a civilian healthcare professional or facility that has no formal agreement with TRICARE contractors (Humana Military or TriWest) and does not belong to the TRICARE provider network.

## What it means in practice If you see a non-network provider, you are still using your TRICARE benefit, but your out-of-pocket costs will almost certainly be higher. These providers have not agreed to the discounted rates that network providers accept. Consequently, TRICARE will pay a smaller portion of the bill, and you may be responsible for the difference between what the provider charges and the TRICARE allowable charge.

There are two distinct types of non-network providers: **Participating** and **Non-Participating**. * **Participating providers** do not belong to the network but agree to accept the TRICARE allowable charge as payment in full on a case-by-case basis. They file the claims for you. * **Non-participating providers** do not accept the TRICARE allowable charge and may "balance bill" you up to an additional 15% above that amount. Furthermore, you will usually have to pay the full bill upfront and file your own claim for reimbursement.

For example, under TRICARE Select in 2026, a Group A retiree seeing a non-network specialist would face a higher deductible and a 25% cost-share of the allowable charge, plus any "balance billing" amounts. If you are enrolled in TRICARE Prime, you generally cannot see a non-network provider without a specific referral from your Primary Care Manager (PCM); doing so anyway triggers the **Point-of-Service (POS) option**, which carries a heavy deductible (typically $300 for individuals/ $600 for families in 2026) and a 50% cost-share.

Choosing a non-network provider is common for beneficiaries who live in remote areas or those who have long-standing relationships with specific specialists who refuse to join insurance networks. However, because these providers are not vetted by Humana Military or TriWest for the T-5 contract standards, TRICARE does not guarantee their quality or billing practices.

## Related terms * **Allowable Charge:** The maximum amount TRICARE will pay for a covered medical service. * **Network Provider:** A civilian doctor or hospital that has signed a contract with the regional contractor to provide care at discounted rates. * **Balance Billing:** When a non-participating provider bills the patient for the difference between the TRICARE allowable charge and the provider's actual fee (limited to 15%). * **Point-of-Service (POS) Option:** An expensive cost-sharing track used when TRICARE Prime members see a non-network provider without a referral. * **Participating Provider:** A non-network provider who agrees to accept the TRICARE allowable charge as payment in full for a specific visit.

## Sources * TRICARE.mil: Find a Doctor [https://www.tricare.mil/findaprovider](https://www.tricare.mil/findaprovider) * TriWest Healthcare Alliance (West Region): [https://www.triwest.com](https://www.triwest.com) * Humana Military (East Region): [https://www.humanamilitary.com](https://www.humanamilitary.com)