Q&A: Non-Covered Services from Network and Participating Non-Network Providers (East Region)

5/25/2022

This article contains information specific to beneficiaries living in the East RegionAlabama, Arkansas, Connecticut, Delaware, the District of Columbia, Florida, Georgia, Illinois, Indiana, Iowa (Rock Island area), Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri (St. Louis area), New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas (excluding El Paso area), Vermont, Virginia, West Virginia, and Wisconsin.. Check the map to find your region.

Have you ever encountered the term “non-covered” service when seeking health care? Using a non-covered service can mean higher costs, so it’s important to understand the process behind it. Below are some frequently asked questions about the non-covered service process, and how it affects you.

Q: What is a non-covered service?

A: A non-covered service is a service that your health care plan doesn’t cover. As the beneficiary, you’re responsible for paying for those costs. All services and supplies related to a non-covered condition or treatment are excluded.

Q: Why is it important to know whether your service is covered?

A: Network and participating non-network providers can’t bill you for non-covered services unless you agree in advance and in writing to pay for these services.

Q: What is a non-covered service waiver?

A: A non-covered service waiver is the written agreement between you, your provider, and your TRICARE contractor, Humana Military. You must request a waiver from Humana Military in advance of the non-covered treatment. You can download the TRICARE non-covered services waiver.

If the provider doesn’t complete and file the non-covered service waiver form before performing the service, then you aren’t responsible for the costs of the non-covered service.

Please note that the waiver must specify that you understand that the service isn’t covered and that you accept financial responsibility. Your provider must itemize the service on the form with the date of service. Also, they must clearly disclose the cost.

Q: Are there any exceptions?

A: Yes. A network provider may not bill you for excluded or excludable services except:

  • If you fail to inform your provider that you are a TRICARE beneficiary

  • If your provider informs you that services aren’t covered, and you agree in advance and in writing to pay for the services

A network or non-network provider not following these rules may be committing fraud. Report provider fraud at the Fraud and Abuse Hotline: 1-800-333-1620.

If you want to learn more about non-covered services, including a list of services TRICARE doesn’t cover, check out the TRICARE Exclusions page.

Last Updated 11/22/2022