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Military Health System

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Balance Billing

Date of Publication:



The practice of a provider billing a beneficiary the difference between the TRICARE allowed amount and the billed charges on a claim. Participating providers and network providers may not collect from all sources an amount that exceeds the TRICARE allowed amount. Non-participating providers may not collect an amount that exceeds the balance billing limit, 115 percent of the allowed charge. If the billed charge is less than the balance billing limit, then the billed charge is the maximum amount that can be collected by the non-participating provider.

Source of Definition:

DoD Instruction 6015.23: Foreign Military Personnel Care and Uniform Business Offices in Military Treatment Facilities

Last Updated: December 05, 2018
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