Eisenhower Army Medical Center
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Third Party Collections

The Consolidate Omnibus Budget Reconciliation Act of 1986 (COBRA) established the Third-Party Collection Program. Under this program Military Medical Treatment Facilities are obligated to bill health insurance carriers for the cost of medical care furnished to patients who have other health insurance.

The Uniform Business Office was the first Medical Treatment Facility to establish and implement billing and collecting procedures for Third Party Collection Program. Billing outpatient visits was initiated in January 1992 and now we have expanded further by billing for ancillary procedures( Rad/Lab) and pharmacy prescriptions from external providers.

The mission of the Third Party Collection Program is to maximum collections in order to enhance patient care.

Third Party Insurance Information Frequently Asked Questions:

What is the Third Party Collection Program? A Congressionally mandated program, which directs military hospitals to bill private health insurance plans when beneficiaries receive care in our hospital.

I thought free medical care was a benefit granted to me. Yes. Your health care is paid for with federal tax dollars. Congress enacted legislation authorizing Medical Treatment Facilities (MTFs) to recover some of the costs incurred providing medical care to beneficiaries with health insurance, in order to share the responsibility with the appropriate parties.

Will I be billed? No. The obligation to pay medical care costs applies only to your insurance carrier. You will not be sent a bill from the MTF for co-payments, deductibles, or precert penalities. If for some reason your insurance carrier does not cover your hospitalization you will be billed the applicable per diem rate. The MTF is entitled to recover the same compensation for it’s health care services that any civilian provider would receive. Your insurance carrier will pay the benefits directly to the MTF. Any deductible or co-insurance amounts are absorbed by the MTF.

What effect will this have on my health insurance premiums if you bill and collect from my carrier? Health insurance is intended to pay for your medical needs as detailed in your policy. The premiums you (or your employer) pay are for coverage of those services, therefore no changes are expected on your individual policy and your premiums will not go up. Your insurance is being used exactly as it is intended. Premium increases are due to inflation and multiple other factors, but not because of claims being filed by MTFs.

Are there any advantages for me? Yes. Most insurance plans have deductibles that must be met before the plan starts to pay. When we file claims, the amount billed will be applied toward the patient’s deductible. Therefore, if the patient visits a MTF frequently and their deductible is met, they will have less out-of-pocket expenditures should they have to visit a civilian health care provider or facility. They will actually spend less money out-of-pocket.

Why should I have additional insurance coverage? The fact remains most military hospitals cannot accommodate all beneficiaries who need medical care. Family members and retirees should consider purchasing supplemental insurance to cover the out-of-pocket expenses when civilian medical care is required. Supplemental plans are available through many military associations.

How are the funds that have been collected from insurance used? The funds collected from the Third Party Collection Program are used to enhance services at the treatment facility; such as purchasing state of the art medical equipment, larger variety of pharmaceuticals, and renovations in order to enhance patient care.