Military hospitals to bill private insurance companies for cost of care

  • Published
  • By Staff Sgt. Kirsten Wicker
  • 325th Medical Group
TYNDALL AIR FORCE BASE, Fla. --  Tyndall's 325th Medical Group is part of a Defense Department-wide program in which military treatment facilities bill private insurance companies for medical services rendered to all non-active duty individuals who are classified as dependents, retirees or spouses.

The Third Party Collection program is directed by Public Law 101-510 (10 U.S. Code 1095). Military hospitals, including the 325th Medical Group clinic and pharmacy on Tyndall, fall under the classification.

"This is especially important if the individual is a dependent and receives health insurance through a civilian employer or other means, but uses the clinic's pharmacy to get their prescriptions," said Staff Sgt. Nicholas Yancey, 325th Medical Support Squadron. "The provider will receive the bill for the cost of the prescriptions that individual is picking up."

When a patient has commercial insurance, the government will bill the insurance company directly for medical services and prescriptions. The program includes all beneficiaries covered under health insurance plans, excluding active duty members, and the program is mandated by Congressional law.

"All non-active duty dependents, retirees and spouses are eligible and should let the clinic know as soon as possible," Sergeant Yancey said.

Individuals who have other health insurance besides TRICARE or Medicare, must complete a DD Form 2569, Record of Other Health Insurance, indicating private health insurance status. This form is updated annually, or upon any changes to your coverage and can be filled out at the Third Party Collection Program desk.

The form contains a signature block at the bottom that certifies all information is true and correct. Falsification of information is covered by Title 18, United States Code, Section 1001, which provides for a maximum fine of $250,000 or imprisonment for five years, or both.

"The information will be entered into our computer system and used to bill your insurance company directly for all medical services received at the 325th Medical Group," said Sergeant Yancey. "This form must be filled out even if TRICARE is your only form of insurance."

Individuals who file will be issued a TPC card at the TPC desk to be shown at all clinic and pharmacy visits. This card prevents the unnecessary filling out of additional forms.

"It is a simple white card that fits in a wallet," Sergeant Yancey said.

According to clinic officials, most insurance plans have a deductible that must be met before the plan starts to pay. When TRICARE files claims, insurance companies cannot charge for the deductible or co-payment for care received at a military treatment facility.

Additionally, the 325th MDG is allowed to keep the money recovered. DoD instructions specify the money be used to increase the quality of care at the medical group. Tyndall's facility has the discretion to spend money as required by priorities.

"We are able to track exactly how much is billed and how much is recovered," said Sergeant Yancey. "The money may be used for essential equipment, supplies, furniture, renovations to the facility and additional staff members."

"The most important things to remember is our level of care will never be impacted by whether or not a person has other health insurance," said Maj. Keshi Surles, 325th MDSS flight commander. "Claims filed by the government for care received may count towards meeting deductibles, possibly resulting in a significant savings to individuals if they later seek civilian medical care."

Furthermore, clinic officials emphasize that the TPC Program will not delay admittance to Tyndall's facility or affect the level of care received. Preferential treatment is not given, no matter what type of coverage an individual may or may not have.

"It's required by law," Major Surles added.

If an individual receives a check for benefits by mistake, turn it in to the TPC desk immediately. For additional information, please call 283-7777 or stop by the TPC desk, located in the clinic building just past the pharmacy on the left-hand side.