Question

Jennifer Ellerhoff is a spouse to an E-5 ADSM stationed in Southeast Asia. She has a family policy with Tricare Select. She has an appointment with a civilian outpatient clinic. The provider is a NonPAR charged her $240. The Tricare allowable charge is $212. After the EOB is received, the clinic sends a bill for $212. She calls and asks why she is held accountable for the bill of $212. How would explain the reason why she owe this amount?

Answer 1

As a Tricare Select beneficiary, Jennifer Ellerhoff is responsible for paying any cost-sharing amounts associated with her medical care, including deductibles and copayments. In this case, the Tricare allowable charge for her appointment with the civilian outpatient clinic was $212, but the clinic charged her $240. The difference between the Tricare allowable charge and the amount charged by the clinic is known as the balance billing amount.

While Tricare will pay for a portion of the cost of Jennifer's care, she is responsible for paying the cost-sharing amount determined by Tricare, which in this case is $212. The clinic should have billed Tricare directly for the services provided, and Tricare would have paid the allowable charge of $212, leaving Jennifer responsible for paying any applicable copayments or deductibles.

If Jennifer is still unsure about why she owes the $212, she can contact Tricare customer service for further clarification.