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What is the Third Party Collection Program?
The Third Party Collection Program (TPCP) requires Military Treatment facilities (MTF) to bill your Other Health Insurance (OHI) for Outpatient visits or Inpatient stays. If you have Tricare AND other health insurance coverage, the government requires that we attempt to collect payment from your third party insurance. In addition to fling claims for office visit and inpatient stays we also bill your insurance for all ancillary services provided such as Pharmacy, Laboratory and Radiology services.
The key to the Third Party Collection Program’s success is you and the OHI coverage that you or your spouse may be paying for, but are not using. We require that you fill out and submit your OHI information on a DD2569 for processing. This should be done annually or upon any change to your coverage. We will then bill your insurance company directly for the cost of your visit.
This program will not delay your admittance to our facility or affect the type of care you receive in our facility. No preferential treatment, based on type of coverage or even the existence of health insurance coverage, will result from the Third Party Collection Program.
It is DoD policy to collect from third-party payers the reasonable charges for medical services provided to Uniform Services beneficiaries, excluding active duty, to the fullest extent allowed under Title 10, United States Code, Section 1095, as implemented by Title 32, Code of Federal Regulations Part 220 and supplemented by Service guidelines.
Who must participate in the Third Party Collection Program?
Tricare members who have Other Health Insurance:
Collectively these categories of patients are called "DoD Beneficiaries"
What effect will this program have on my health insurance?
None. Health insurance is intended to cover you and your family's needs for the medical services listed in your policy based on the premiums you and your employer pay for those services. Since you are providing that policy so we can collect the cost of providing you with healthcare, the insurance is being used exactly as it should be. Health insurance premiums, unlike automobile insurance premiums, usually do not increase due to hospitalization. They're usually determined by calculated statistical risk data based on an entire insured group. This means that under most circumstances, your rates will not be affected.
Where does the money go?
Payments from your healthcare insurer go directly to our Medical Treatment Facility's operating budget. The money is then used to enhance the total healthcare services offered to you.
If the full cost of care is not collected, will I get a bill from the hospital or my insurance company?
No. You will not be billed for any costs that we cannot collect. You will receive a written Explanation of Benefits (EOB) from your Health Insurance Carrier. It will tell you how much was paid to us and what deductibles or co-payments were subtracted from the claim we filed. This is not a bill – it is merely an explanation for your personal records. You are not responsible for co-payments or deductibles not paid to us by your Health Insurance Carrier, even if they appear on your Explanation of Benefits. Most insurance plans have a deductible that must be met before the plan starts to pay. When we file claims, the amount billed will be counted toward your deductible. As a result, you will actually spend less money out of pocket. It will not have a negative effect on your medical treatment. Instead, this program will allow us to continuously maintain services and improve our healthcare facilities. That simply means every time you enter our clinic, you can be assured that you’re receiving the very best healthcare available today, whether you have third party insurance or not.
The obligation to pay medical care charges applies only to the Health Insurance Carrier. You will not be sent a bill for the amounts not covered by the carrier. We are entitled to receive the same reimbursement from Third Party Payers (other health insurers) that any other medical care providers would receive. Money collected under the TPCP goes directly to us to provide enhanced healthcare to you. Your insurance company will pay benefits directly to us and you will not be billed for any uncollected charges.
Should your insurance company reject your claim in its entirety or you don’t have insurance, you may be billed the subsistence charge for an inpatient stay, if applicable.
Do I need to provide my insurance information with every visit?
To collect benefits covered by your health insurance, we must verify information that appears on your health insurance identification card. Please have this card with you every time you visit a clinic.
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