Third Party Collection Program

  • Published
  • By Resource Management Office
  • 28th Medical Group
The following questions and answers provide information about the Third Party Collection Program. The program directs military hospitals and clinics to bill private health insurance plans when beneficiaries receive care in a military treatment facility. The program includes all beneficiaries covered under health insurance plans, excluding active duty members, and the program is mandated by Congressional law.
The TPCP program began billing insurance companies more than eight years ago for inpatient care and more than four years ago for outpatient care. Officials said the program is specifically intended for the base's retiree and dependent beneficiaries. 

What is TPCP?
The TPCP is a congressionally mandated program that authorizes military treatment facilities to bill private health insurance plans for services provided here at the 28th Medical Group. It bills for immunizations, physical therapy, optometry, pharmacy, lab and radiology. If you are a retiree or dependent and have private health insurance, you are required to participate.

What do I need to do?
If you have other health insurance besides TRICARE or Medicare, all you must do is complete a DD Form 2569, Third Party Collection Program - Insurance Information, indicating private health insurance status. This form, updated annually, will be kept in your medical record. The information will be entered into our computer database systems and will be used to bill the insurance companies for all medical services received here.

What kinds of health insurance plans are included?
This program includes employer-sponsored health insurance, group plans such as those offered by associations, private individual policies, and Medicare supplemental policies. The following types of insurance are excluded from billing: Medicare for people over age 65, TRICARE, TRICARE supplemental policies, and Medicaid.

Why does TRICARE have to participate in this program?
Congress directed and the Department of Defense implemented the program. Policyholders pay premiums for coverage, and TRICARE is obligated to collect money to reimburse the Air Force for services provided. In other words, TRICARE is doing exactly what civilian hospitals do every day. With medical costs continuing to rise every year, this reimbursement allows the Air Force to keep pace financially.

Are there any advantages to the patient?
Yes. Most insurance plans have a deductible that must be met before the plan starts to pay. When TRICARE files claims, the amount billed to the patient will be counted against the patient's deductible. Therefore, if the patient visits the hospital a few times and pays their deductible, they will actually spend less money out of pocket.

What are the disadvantages to the patient?
Some people look at TPCP as an erosion of benefits and think insurance premiums will rise as a result of this program. This is not true.

How will the collected money be used?
TRICARE is allowed to keep the money recovered. DoD instructions specify the money be used to increase the quality of care. Therefore, our 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. The money may be used for equipment and supplies, furniture, renovations to the facility and additional staff members.

What is the clinic required to do in the TPCP program?
Each clinic performs a vital role in the TPCP process. Accurate data collection is the key to successful billing. The forms provided to the patient are designed to be easy to complete, but questions are anticipated. The clinic staff will try to answer questions when possible; however, the TPC office is the point of contact for the program.

Is there anything else important to know about the form?
The form contains a signature block at the bottom that certifies all information is true and correct. The information will be entered into a database, and the information will be checked against other databases to ensure there is information on all plans. If someone chooses not to tell medical personnel about a plan, and it is later discovered that the patient does have one, the patient will be counseled. This misrepresentation could result in a fine of $10,000 and five years in prison.

For more information, call the resource management office at 385-3311 or 385-3352.