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News | March 16, 2021

Explore Your Provider Options With TRICARE Overseas Program

By TRICARE Communications

Are you looking for a doctor overseas? If so, the TRICARE Overseas Program (TOP) can help you find one. Depending on your sponsor’s status and where you live overseas, you may only be able to get care at a military hospital or clinic if space is available. But the good news is that you do have a wide range of civilian providers you can see for care.
 
“As a TOP beneficiary, you have access to an extensive network of civilian providers,” said Michael Griffin, program analyst with the TRICARE Overseas Program Office at the Defense Health Agency. “It’s important to make sure you see a TRICARE-authorized provider whenever possible. These providers meet TRICARE’s policies for coverage and help you get the quality care you need. Your out-of-pocket expenses may also be much lower when you see one of them.”
 
The TRICARE-authorized provider you choose depends on the type of care you need and your coverage. You have the option of seeing either a network or participating non-network provider. Here’s a look at all of your overseas provider options and why they’re important.
 
Getting care from a network provider
Did you know that seeing a network provider may save you money? As outlined in the TRICARE Overseas Program Handbook, network providers are certified by TRICARE to give you the care you need. These providers have a formal agreement with the TOP contractor, International SOS Government Services, Inc. (International SOS). They may also provide cashless and claimless medical services to those enrolled in TOP Prime and TOP Prime Remote. Keep in mind, overseas network providers aren’t required to file claims if you use TOP Select. If you aren’t an active duty service member or command-sponsored active duty family member, you may be required to pay for services up front and file a claim for reimbursement.  
 
Overseas network providers are only available in certain areas. To find a network provider near you, use the Overseas Provider Directory. If you wish to clarify or confirm the type of provider, you can call the TOP Regional Call Center.
 
Getting care from non-network providers
Like network providers, non-network providers are also TRICARE-authorized. However, these providers haven’t signed an agreement with International SOS. There are two types of non-network providers—participating and nonparticipating.  
 
“Participating non-network providers may offer cashless or claimless care to those who have TOP Prime or TOP Prime Remote,” Griffin said. “If this isn’t offered, you’ll pay for the cost of your care up front and need to file a claim after your visit.”
 
You should also expect to pay the full cost of your care up front when you see a nonparticipating non-network provider. After you receive care, make sure you file a claim to get your money back. Keep in mind, the amount you pay may vary. The TRICARE Overseas Program Handbook states, “Outside of the U.S. and U.S. territories, there may be no limit to the amount nonparticipating non-network providers may bill, and you’re responsible for paying any amount that exceeds the TRICARE-allowable charge.” This charge is the most TRICARE will pay your doctor or other provider for a procedure, service, or equipment.    
 
Getting care in the Philippines
Do you live or travel in the Philippines? If so, you’re required to see a TRICARE certified provider for your medical and pharmacy care. When you visit a certified provider, you may be required to pay at the time of your service. You may also need to file your own claim for reimbursement. You’re responsible for any costs above the TRICARE-allowable charge in addition to your deductible and cost-shares.
 
If you have TOP Select and live or travel in the Philippines, you must see a certified provider. But you’re encouraged to see a TRICARE-preferred provider. When you see one of these providers, you may have lower out-of-pocket costs. They may also file claims for you. At the time of your visit, preferred providers will ask you to fill out an agreement to pay applicable cost-shares and deductibles. You can pay up front or may be billed afterwards.
 
To find a provider in the Philippines, use the Philippine Provider Search Tool.
 
As you search for an overseas provider that meets your needs, remember that some services may require a referral or pre-authorization depending on your plan’s rules. And you’re responsible for paying the full cost of any care that TRICARE doesn’t cover. To learn more about costs associated with your care, use Compare Costs Tool or check out the TRICARE Costs and Fees Sheet.
 
Take command of your health, and reach out to International SOS if you have questions.
 
U.S. Navy Cmdr. Candida Ferguson, a general surgeon at Naval Hospital Jacksonville, talks with a patient about colorectal cancer screening. The Defense Health Agency established new age recommendations for screenings. Regular screening with a stool test, sigmoidoscopy, or colonoscopy, beginning at age 45, is the key to preventing colorectal cancer and finding it early.

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