TRICARE and Non-Covered Services
What to know about TRICARE and non-covered services.
TRICARE most likely covers most of what you need to stay healthy, both physically and mentally, to help you get well after an illness, or to help you heal after an injury. However, there are services they don’t cover. This can complicate things, especially if the service is something you think you need to have. Here is a little bit about what you need to know about TRICARE and non-covered services.
What are the TRICARE exclusions?
TRICARE usually excludes services and supplies that they do not think are medically or psychologically necessary to treat or diagnose a covered illness, injury, pregnancy, or well-child care. Keep in mind that all services and supplies that are related to a non-covered condition or treatment, or provided by an unauthorized provider are excluded. According to TRICARE, these are their current exclusions:
- Alterations to Living Space
- Alternative Treatments
- Assisted Living Facility Care
- Augmentation Mammoplasty
- Autopsy Services
- Aversion Therapy
- Blood Pressure Monitoring Devices
- Charges for Missed Appointments
- Computerized Dynamic Posturography (CDP)
- Cosmetic Drugs
- Domiciliary Care
- Dry Needling
- Dynamic Posturography
- Dyslexia Treatment
- Elective Psychotherapy and Mind Expansion Psychotherapy
- Elective Services or Supplies
- Elevators or Chair Lifts
- Exercise Equipment
- Exercise Programs
- Experimental Procedures
- Fluoride Preparations
- Gym Membership
- Homeopathic and Herbal Drugs
- Hospitalization for Medical or Surgical Error
- LASIK Surgery
- Learning Disorders
- Long Term Care
- Medical Care from a Family Member
- Mental Health Exclusions
- Multivitamins and Megavitamins
- Mycotoxin Testing or Toxic Mold Testing
- Naturopathic Care
- Nursing Homes
- Paternity Test
- Personal Items
- Postpartum Stay without a Medical Reason
- Private Hospital Rooms
- Psychiatric Treatment for Sexual Dysfunction
- Psychogenic Surgery
- Retirement Homes
- Safety Medical Supplies
- Sensory Integration Therapy
- Sexual Dysfunction or Inadequacy Treatment
- Transcutaneous Electrical Nerve Stimulation (TENS)
- Therapeutic Absences from Inpatient Facility
- Uncovered Services and Supplies
- Unnecessary Diagnostic Tests
- Unnecessary Inpatient Stays
- Unproven Procedures
- Vestibular Rehabilitation
- Vision Therapy
- Vitamin D Screening
Can you still use non-covered services?
Technically you can, but you would have to pay out of pocket for them. Depending on what the service is, that might not be an option.
Can you get a waiver for non-covered services?
Yes, you can. The waiver is a written agreement between you, your provider, and your TRICARE contractor, Humana Military. You will need to request the waiver before you get the treatment. You can download a TRICARE Covered Services Waiver. If you give the waiver to your provider to fill out and they do not complete the waiver and file it before performing the service, then you are not responsible for the costs of the non-covered service.
The only time your network provider should bill you for excluded or excludable services is if you fail to inform your provider that you are a TRICARE beneficiary, or if your provider informs you that the service isn’t covered and you agree in advance and in writing to pay for the services.
A network or non-network provider that isn’t following the rules could be committing fraud, so make sure you understand what is covered and what isn’t. The good thing to remember is that things can change in the future, and it is possible that something that isn’t covered right now could be covered by TRICARE in the future.
About the author
Julie Provost is a freelance writer, blogger, and owner of Soldier's Wife, Crazy Life, a support blog for military spouses. She lives in Tennessee with her National Guard husband and three boys.