You are here

TRICARE Appeals

TRICARE CardTRICARE is insurance that covers most inpatient and outpatient care for current and retired military personnel. However, there are special rules or limits on certain types of care, while other types of care are not covered at all. If you feel that denial of service is wrong, you can appeal the decision.

TRICARE is a health insurance plan for military personnel, military retirees and their dependents, and some members of the Reserve. TRICARE used to be called Civilian Health and Medical Program of the Uniformed Services (CHAMPUS).

If you have TRICARE and your drug or service is denied, you can appeal. An appeal is when you ask your insurance (like TRICARE) to change their decision. Sometimes an appeal is called a “request for reconsideration.” The decision document that TRICARE sends you is sometimes called a “claim decision.”

You have up to 90 days from the date of your “claim decision” to appeal to TRICARE.

To appeal a TRICARE benefit decision, you need to include:

  1. A signed written document that includes:
    • Your name
    • Your address
    • You phone number
    • The exact reason you don’t agree with the claim decision
    • The name of the drug or service you want them to cover
  2. A copy of the claim decision
  3. If you have an appointed representative, a copy of the “appointment of representative” form
  4. Any other information that may help, including medical records

Mail all this to:
Express Scripts, Inc.
P.O. Box 60903
Phoenix, AZ 85082-0903

Additional TRICARE Information

For additional information on TRICARE appeals, go to: www.tricare.mil

OR

Call Express Scripts, Inc. at:
In the U.S.: 1-877-363-1303
Outside the U.S.: 1-866-275-4732 (where toll-free service is established)

Find a Support Group

Go

 

Learn more about spasticity - a common post-stroke condition

Seeking more information about spasticity? The Spasticity Alliance is here to help.

Learn more

Get Involved

 

For over 30 years we have been the trusted source for free resources and education to the stroke community. Together, we empower survivors and their circle of care to thrive after stroke. Make your tax-deductible donation today to support the growing needs of the stroke community.