When managing the Medical Billing for your medical practice, the better you understand the payment process, the better you can care for your patients. Your understanding of what a patient will owe and what will be covered can help them navigate the confusing world of medical insurance.

An area of confusion for veteran patients in your office is what Tricare benefits are available to assist with their medical services.

Tricare, the United States Military’s Health Insurance Plan, covers active-duty members, retirees, and their families. (Note: there are 4 parts to Tricare, all of which are covered in detail in another article.)

These service covers most inpatient and outpatient care that is medically necessary and considered proven.

However, there are special rules or limits on certain types of care, while other types of care aren’t covered at all. Some services or treatments require prior authorization.
Some treatments are not allowed or covered. A few examples of medical procedures that aren’t covered are:

– Cosmetic surgery or drugs used for cosmetic purposes (e.g. Botox). However, cosmetic surgery to correct a disfigurement, such as the result of an accident or burn, is covered.

– Most dental work. However, dental care that is medically necessary in the treatment of an otherwise covered medical (not dental) condition is covered.

– Nonsurgical treatment for obesity or weight control.

– Smoking cessation products and treatment.

– Abortions (unless the medical professional deems the mother’s life to be at risk).

– Some forms of birth control that do not require a prescription. However, items such as prescription birth control pills, are covered.

For a complete list of treatments not covered by Tricare, you can also visit the website.