TRICARE 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.
- 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
- A copy of the claim decision
- If you have an appointed representative, a copy of the “appointment of representative” form
- 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
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)