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Our patient's primary insurance paid more than TRICARE allows. Is the patient responsible for the remaining balance?
No, your patient is not responsible for the balance. When you "accept assignment" on a TRICARE claim, you accept the TRICARE maximum allowable charge as payment in full. When your patient's Other Health Insurance (OHI) pays more than the TRICARE maximum allowable charge, you are paid in full.
If a non-network doctor does not accept assignment on a claim, federal law limits what the doctor can bill the patient to no more than 115% of the TRICARE maximum allowable charge.