Patient Administration Division
Other Health Insurance
Frequently Asked Questions
HOW WILL THE
THIRD PARTY COLLECTION PROGRAM HELP YOU?
It helps to ensure the services, which are available to you, will be available in the future, by offsetting budget reductions enacted by Congress.
If your insurance company reimburses TAMC, then you will not be responsible for paying subsistence and medical service charges.
Claims filed by TAMC may help meet your deductible, thus saving you money if you subsequently receive treatment from a civilian provider (up to $500.00 annually).
WILL MY INSURANCE
COMPANY BILL ME?
NO. You will not be billed.
The obligation to pay medical care costs applies only to the insurance carrier. You will not be sent a bill for amounts not covered by the carrier. We are entitled to receive those same benefits from third-party payers that any other medical care provider would receive. Money collected under this program goes directly to the TAMC 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.
IF THE FULL COST OF
CARE IS NOT COLLECTED, WILL I GET A BILL FROM THE HOSPITAL OR MY INSURANCE
NO. You will not be billed for any costs that we cannot collect. You will receive a written Explanation of Benefits (EOB) from your insurance company. This form 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 insurance company, even if they appear on your Explanation of Benefits form.
WILL MY HEALTH INSURANCE
NO. Health insurance is intended to cover you or your family's needs for the medical services listed in our policy, and the premiums you or your employer pays are for those services. Since you are providing other health insurance information so we can collect the cost of providing you with enhanced healthcare, your insurance is benefiting you exactly as it should. Health insurance premiums, unlike automobile insurance premiums, do not increase due to outpatient treatment or hospitalization. Insurance premiums are determined by calculated statistical risk data based on your entire insured group.
WILL I HAVE TO PAY A DEDUCTABLE?
Many insurance plans have a deductible that must be paid by the insured before
any money is contributed by the insurance company. When the TAMC bills the
insurance company, the amount of the deductible is first subtracted by the
insurance company before any dollars are reimbursed to the hospital.
The deductible gets paid, but not out of your pocket.
For patients who have an annual deductible and require future care in a civilian
facility, this represents a significant savings.
DO I NEED TO PROVIDE MY
INSURANCE INFORMATION WITH EVERY VISIT?
Our clinic personnel
will be asking you for this information at every visit.
Please have your health insurance card with you every time you come to the
hospital to ensure our records are up to date. To collect benefits covered by
your health insurance, we must have the information that appears on your health
insurance identification card.
WHERE DOES THE MONEY GO?
Payments from your healthcare insurance company go directly to the WBAMC. The money is then used to meet budget requirements and enhance the total healthcare services offered to you at our facility. Since the program's inception, critical pieces of medical equipment and other hospital enhancements have been funded using money collected.
WHAT ARE THE LEGAL ASPECTS OF
The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) established
the Third Party Collection program. Under this federal program, Military Medical
Treatment Facilities are authorized and
obligated to bill health insurance
carriers (like Blue Cross or Prudential) for the cost of medical care furnished
to military retirees and family members who are covered by health insurance
policies. Intentionally providing false information or willfully failing to
provide insurance information are grounds for disqualification for health
services from military health care facilities. We, as a military facility, must
comply with these laws and we need you help to make this program a success.
HOW DO I REPORT MY OTHER HEALTH
If you have any more questions about the Third Party Collection program, or
would like to submit your insurance information directly
to us please contact the Third Party
Tripler Army Medical Center
1 Jarrett White Road
Honolulu, Hawaii 96859-5000
Attn: Third Party Collections
Phone (808) 433-6107
FAX (808) 433-9025
You are also welcome to stop by our office anytime, we would be happy to assist you.