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My doctor charged more than TRICARE allows. Do I have to pay the difference?
The Department of Defense Appropriations Act of 1993 (also known as the Balance Billing Act) says non-participating providers may not bill you for more than 115% of the TRICARE allowed amount. If you are charged more than 115% of the TRICARE allowed amount, contact your local TRICARE Service Center (TSC) to find out if your doctor is violating a federal law.
For dates of service January 1, 1999 and after, all non-participating providers must follow the guidelines of the Balance Billing Act. Failure to comply may exclude a provider from the TRICARE program. Before this date certain providers (such as ambulance companies) were exempt. For a list of these providers, please see your TRICARE Handbook or contact your local TSC.
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