TRICARE denial appeals
TRICARE is the U.S. Department of Defense health program covering active-duty servicemembers, retirees, and eligible family members. Appeals are governed by 32 CFR Part 199, administered by regional contractors (Humana Military and TriWest), with final review by the Defense Health Agency (DHA).
Patterns we see on TRICARE denials
Regional contractor reconsideration first
TRICARE appeals begin with reconsideration by the regional managed care support contractor — Humana Military (East) or TriWest (West). The reconsideration request must be in writing and is typically due within 90 days of the initial denial.
Formal review by DHA
After contractor reconsideration, members can request a formal review by the Defense Health Agency. This step is the gateway to a hearing and is the prerequisite to any further federal review.
Independent hearing for higher-dollar cases
TRICARE provides an independent hearing for appeals meeting a minimum amount-in-controversy threshold. The hearing officer's recommendation goes to the DHA Director for a final agency decision.
Contractor reconsideration, formal review by DHA, then independent hearing (above the amount-in-controversy threshold), then DHA Director final decision.
90 days from denial for reconsideration; 60 days from each subsequent adverse decision for the next level. Urgent / pre-authorization timelines compress to 72 hours.
How we file TRICARE appeals
TRICARE rules are federal — state DOI external review does not apply. We brief appeals against 32 CFR Part 199 and the TRICARE Operations Manual specifically.
Got a TRICARE denial?
Two-minute micro intake. We confirm fit and reply within one business day. No card at intake — pay only if we win (20% of recovery, $5,000 max). self-guided Express package.
Start Your AppealDisclaimer: information shown is general guidance, not legal advice or a guarantee of outcome. Individual case outcomes depend on documentation, timing, and the specific terms of your plan.