Tricare and CHAMPUS
Coverage limitations apply to CHAMPUS and the various Tricare plans. CHAMPUS and the various Tricare plans have specific payment restrictions for certain diagnostic services, utilization limits on visits or consultation and procedures that CHAMPUS and Tricare deem not proven effective.
To avoid paying a pre-service deposit or experiencing either denial of payment or a reduction of benefits, Mayo Clinic highly recommends you contact your insurance carrier prior to services to determine plan requirements or limitations to receiving care at the Mayo Clinic site at which you will receive services.
If you have any additional insurance coverage, please provide this information to Mayo Clinic at the time you are making your appointment.
Referrals (formerly NAS) and pre-authorization
- It is your responsibility to contact your nearest military health-benefit adviser to find out if you need a physician-written referral. A physician-written referral is required for inpatient admissions and some outpatient procedures.
- Pre-authorization is required for nonemergency hospital admissions and other outpatient procedures. Please call your military health-benefit adviser, refer to your Tricare or CHAMPUS benefit manual, or reference plan websites for more information.
After each visit, Mayo Clinic will send patients an itemized statement of charges detailing the services and charges for the visit and, separately, a monthly statement listing the payments and adjustments made on each visit since the previous monthly statement. Your personal financial responsibility, as noted on the Tricare or CHAMPUS explanation of benefits (copayments, deductibles and noncovered charges), is due as noted on the statement.
Mayo Clinic will bill full fees and has agreed to accept the established CHAMPUS or TRICARE fee schedule payment for services being provided. As payment is received, the account will be adjusted to the established CHAMPUS or TRICARE fee schedule and patients will be responsible for paying deductibles, cost-share and noncovered services. Typically, CHAMPUS and the various Tricare plans do not pay in full for services provided.
Active duty members
A referral directly from the member's commanding officer is required. You must bring your uniformed services ID card.
HealthCare.gov: Health care coverage options for military veterans
May 21, 2016