Certain state insurance laws say claims must be filed within a certain time-frame. If DoD doesn’t find out about a beneficiary’s other health insurance in enough time, the likelihood is we’ll take the money away and the provider will bill the beneficiary directly for the entire amount.
By Terri Moon Cronk
DoD News, Defense Media Activity
WASHINGTON, July 29, 2015 – The Defense Department wants to remind its health care beneficiaries who carry commercial health insurance to provide their policy information to their TRICARE providers, a Defense Health Agency official said recently.
Mark Ellis, a DHA senior health program analyst, said the issue is important to DoD because by law, commercial health care insurance companies pay first and TRICARE pays second on medical bills.
When commercial health care insurers pay first, it saves DoD and insured patients money, because beneficiaries will have little to no copayments, he said.
“Beneficiaries don’t pay their normal cost shares and deductibles, because the other health insurance combined with the TRICARE insurance typically covers most of their out-of-pocket expenses,” Ellis pointed out.
Providing other insurance information to a health care provider is a law that’s been on the books for some time, Ellis noted.
Why TRICARE Beneficiaries Buy Commercial Insurance
Veterans, family members and sometimes even service members carry commercial health insurance in addition to having TRICARE coverage — for a variety of reasons, he said.
DoD surveys show about 14 percent of veterans and spouses who work receive employer-sponsored coverage, Ellis said. And the Affordable Care Act mandates all U.S. citizens have health insurance or face penalties, he added.
In some cases, retirees purchase insurance to cover older dependents who are past the age to use TRICARE, Ellis noted.
Or, a service member’s spouse might have to pay for commercial health insurance if he or she works for a company that employs more than 50 people, according to the Affordable Care Act, he said.
Active-duty personnel who purchase other health insurance only total about 5 percent of DoD’s health care beneficiaries, Ellis added.
Tell Provider About Insurance
It’s essential for TRICARE beneficiaries to tell health care providers if they carry commercial insurance, Ellis emphasized.
“If we find out about it later, by law we have to make sure TRICARE is the secondary payer,” he said.
DoD is concerned some beneficiaries aren’t providing their commercial health insurance information to TRICARE, Ellis said.
Because of that, DoD uses what Ellis called an “industry standard” to obtain evidence from commercial firms when military beneficiaries have other health insurance.
Beneficiaries Can Face Consequences
DoD is looking for beneficiaries who do not provide their commercial health insurance information to TRICARE providers, Ellis said. DoD can retrieve money it is owed from the health care providers who performed the services, he added.
Such a process can cause frustration for the provider and the beneficiary in particular, Ellis said.
“It puts [beneficiaries] at risk for having to pay the whole bill,” he said.
Certain state insurance laws say claims must be filed within a certain timeframe, he said.
If DoD doesn’t find out about a beneficiary’s other health insurance in enough time, Ellis said, “the likelihood is we’ll take the money away and the provider will bill the beneficiary directly for the entire amount.”
Insurance Misnomer Can Exist
Some beneficiaries with commercial health insurance believe their premiums will go up if they use it, Ellis said, adding that is not the case.
When beneficiaries with commercial health insurance are proactive and volunteer the information to TRICARE health care providers, it’s a win-win situation for them and the taxpayer, he said.
“We hope folks will understand we’re doing what we need to do to make sure the taxpayers and [patients] benefit from this project,” he said.