What to know about TRICARE and non-covered services.
TRICARE is designed to provide comprehensive healthcare coverage for qualifying military members and their families. 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.
Changes In TRICARE Exclusions for Prenatal and Preconception Testing
In 2023, the Defense Health Agency (DHA) announced certain prenatal and preconception diagnostic testing formerly not covered by TRICARE due to being deemed “not medically necessary” is moving from the jurisdiction of a DHA pilot program to being covered under TRICARE. According to the TRICARE official site, enrollees are now covered for “one test per condition per lifetime” for the following conditions:
- Cystic fibrosis
- Spinal muscular atrophy
- Fragile X syndrome
- Tay-Sachs disease
- Hemoglobinopathies
- Conditions linked with Ashkenazi Jewish descent
TRICARE retroactively approved these tests as covered screenings back to Dec. 27, 2021. Call your TRICARE regional contractor to learn how to submit a claim for these tests. You can also request that TRICARE reprocess a denied claim.
What are the TRICARE exclusions?
TRICARE does not cover services deemed not 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 may also be excluded. According to TRICARE, these are their current exclusions:
- Acupuncture
- Alterations to Living Space
- Alternative Treatments
- Assisted Living Facility Care
- Augmentation Mammoplasty
- Autopsy Services
- Aversion Therapy
- Blood Pressure Monitoring Devices
- Camps
- 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
- Massage
- Medical Care from a Family Member
- Mental Health Exclusions
- Multivitamins and Megavitamins
- Mycotoxin Testing or Toxic Mold Testing
- Naturopathic Care
- Neurofeedback
- Nursing Homes
- Orthoptics
- 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 must pay out of pocket for them.
Can you get a waiver for non-covered services?
The short answer is, it depends.
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.
Typically your network provider should bill you for excluded or excludable services 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.
Who to Contact About TRICARE Non-Covered Services
The TRICARE official site has an online form you can use to submit questions about benefits, covered and non-covered services, etc. You may also call TRICARE at 1-800-538-9552 for assistance with eligibility and related issues.