Unformatted text preview: TRICARE TRICARE
By Heather Lisowski Introduction Introduction In this presentation I am going to go over some very important information on TRICARE that everyone will need to know when you work in the medical field. I hope that when I am done showing you the importance of this health insurance plan you will understand it a lot better. Eligibility Eligibility
• • TRICARE is a health insurance just for active and TRICARE retired military and their families. retired In order to be eligible for TRICARE they have to be in active duty for thirty consecutive days or retired at the age of sixty. Covered and non covered services Covered and non covered services
• • • When you have TRICARE everything is covered When The only time service is covered is if you are a The retired military and you are on a different TRICARE plan. TRICARE TRICARE only will pay for services that is TRICARE covered by the health insurance. covered Network and non network Network and non network providers • • • Provider's that are authorized to care for a TRICARE patient may also be contracted to become part of the TRICARE network. Provider’s who choose not to become part of the network can still work on the patient but TRICARE will not pay for the services. The patient will be one hounded percent responsible to pay for the service given to them. Participating and non Participating and non participating provider charges.
• TRICARE has an allowable charge and the patient will not have to pay for anything when they go and see a doctor or go to the hospital.
Individual providers may decide whether to participate on a case-by-case basis. A provider who chooses not to participate may not charge more than 115 percent of the allowable charge. • • Reimbursements Reimbursements
• Providers who participates in the TRICARE plan Providers are paid the amount specified by the Medicare fee schedule. schedule. • Medical supplies, durable medical equipment,
and ambulance services are not subject to Medicare limits. TRICARE will only pay for procedures that known as an allowable charge. • Conclusion Conclusion I hope by now everyone can get a better understand on what TRICARE is and how it works. Also how important it is to know the guidelines to TRICARE. guidelines ...
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- Spring '10
- allowable charge