Tricare helps customers understand allowable charges with Web site

  • Published
  • By TRICARE
  • AF Medical
Tricare Management Activity posted its allowable charges on an easy-to-use Web site.
The cost of medical care varies widely across the country, and neither hospitals nor doctors' offices usually post their charges for various procedures. 

That makes it hard for patients to judge if they're being charged a reasonable amount for operations or examinations. By making its maximum allowable charges easily available to the public, Tricare's intent is to level the playing field a little between medical service providers and users. 

"We have a responsibility to help educate the public on health care issues," said William Winkenwerder, Jr., assistant secretary of defense (health affairs.) "With medical costs continuing to spiral upward, the more the consumer knows the better. This information could be especially useful for people with no insurance, who may be able to negotiate pricing with their physicians." 

The new Web site shows the Tricare Maximum allowable charge tables, listing the most frequently used procedures, more than 300 of them, and the amount Tricare is legally allowed to pay for them. These charges are tied to Medicare allowable charges, effectively making them a federal standard for health care costs. 

Tricare figures the allowable charge from all professional (non-institutional) providers' bills nationwide, with adjustments for specific localities, over the previous year. A claims processor can tell a provider the allowable charge amount for specific services or procedures and now, anyone can see the charges on the new Web site. 

The rate table uses the Healthcare Common Procedure Coding System. The charges in this table don't reflect discounts regional contractors may negotiate with Tricare network providers, so they may differ from the amounts shown on TRICARE beneficiaries' explanation of benefits. 

The Tricare allowable charges are listed on line at www.tricare.osd.mil/allowablecharges.