Please note: Our network participation with TRICARE ended December 31, 2017.
Most of the providers in our group are authorized non-network provider with TRICARE. This means that we submit claims on your behalf, and we accept the fee that TRICARE allows, based on the terms of your benefits plan. You are not balance-billed for the difference between our usual fee, and the fee allowed by TRICARE. You are financially responsible for any co-payments/co-insurance, deductibles, and non-covered services.
Please note: although we submit claims to TRICARE on your behalf, as non-participating providers we do not accept assignment of benefits. This means that your therapist will be asking for payment at the time of service, and that TRICARE will send you the benefit check after they process the claims that we send to them.
Please note that providers electing not to accept assignment of benefits are permitted by TRICARE to charge a fee that is 15% higher than TRICARE’s usual reduced fee. The TRICARE website includes this explanation:
Federal law limits the amount you can be billed if your doctor does not accept assignment on the claim. When a provider does not accept assignment, the provider can be paid no more than 115% of the TRICARE allowable charge by law.
In double coverage situations, TRICARE will pay the lower of:
• The billed charges; or
• 115% of the TRICARE maximum allowable charge
* * *
Referrals and Authorizations: TRICARE East Region benefits are administered by Humana Miliary. Depending on your plan (Prime versus Standard), you will need to take certain steps prior to your initial appointment to make full use of your benefits:
TRICARE Prime subscribers can self-refer for counseling and psychotherapy services, but need to get a referral from their Primary Care Manager (PCM) to a specific therapist prior to any testing service.
TRICARE Select allows subscribers to self-refer to a provider of their choosing without a referral from their PCM.
Active Duty military can request a referral from their PCM to receive services from any provider in our group.