discrimination in the admission and/or treatment of patients on the basis of race, color,
or national origin.
Sources. When seeking civilian health benefits, the eligible person should
determine whether the source of care is a participating provider of health care services
under the TRICARE.
a. A provider is the person, business, or institution that provides or gives you
health care. For example, a doctor is a provider. A hospital is a provider. An
ambulance company is a provider. There are many other types.
b. Providers who participate in TRICARE Standard agree to accept the
TRICARE Standard allowable charge as their full fee for your care.
NOTE: Accepting assignment means the same as participating).
c. Providers must be approved or authorized (certified) by TRICARE. T hat
usually means the providers are licensed by their state, are accredited by a national
organization and/or meet other standards of the medical community, and have a
complete certification package on file with the appropriate TRICARE contractor. If a
provider is not authorized, TRICARE Standard cannot help pay for care from that
provider. Most hospitals and doctors are authorized by TRICARE. However, you must
always check with them to be certain. But for other types of providers, it is a good idea
to check with your regional contractor, TSC or HBA before getting care to make sure
they are authorized by TRICARE.
d. Generally, active-duty service members and civilian employees of the federal
government are not authorized to be providers of care under TRICARE. So, TRICARE-
eligible persons should be careful about seeking treatment from the outside practices of
federal government medical personnel.
e. Except in unusual circumstances approved by the Secretary of Defense,
payment cannot be made for inpatient or outpatient care provided in or billed by a
civilian facility found to practice discrimination in the admission and/or treatment of
patients on the basis of race, color or national origin. Reimbursement cannot be made
to an eligible person who pays for care in such facility and submits a claim for
reimbursement. Payment of an attending physician and/or other professional or
paramedical personnel who do not bill through the facility is not refused solely because
services were provided at a facility practicing discrimination.
f. A facility may be disqualified from participation in TRICARE if found by the
Secretary of Defense or field activity to be providing services that are substandard or
charging excessive amounts for services. When such a determination is made, the
facility is notified that it is no longer qualified to participate in TRICARE and that