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Library > Fact Sheets > 18 MDG Pay Patient Guide
18 MDG PAY PATIENT GUIDE
Posted 8/8/2007
Printable Fact Sheet
What is a Pay Patient?
Someone eligible for health care in a military medical facility on a reimbursable basis while they are employed overseas. Pay patients include:
1. DoDDs teachers and their family members
2. GS civilian employees and their family members
3. AAFES employees and their family members
4. US Government contract employees and their family members
Availability
Pay patients and their family members have access to care at the 18th Medical Group on a space available basis. Unfortunately, due to appointment unavailability, the Pediatric Clinic and Life Skills Support Center does not treat pay patients.
Medical treatment facilities are also available for Host Nation providers on the local economy.
Closed Medical Records System
Here at the 18 MDG we have implemented a closed medical records system. We have a courier system that transports your records between military treatment facilities (MTF) for your appointments. In short, there won't be a need for you to hand-carry your medical records. If you transfer to an overseas base, Outpatient Records will mail your records to that MTF. If you are transferring stateside, you will be provided copies of your medical records. Please give 30 days notice. It is DoD policy that medical records are government property and must be maintained in a MTF at all times.
Pay Patient Charge Rates
Outpatient Itemized Billing (OIB)
Who determines what a pay patient is charged?
Public law requires DoD to recover the reasonable cost of healthcare services provided. The same rates apply to health care provided by all uniformed services: Army, Navy and Air Force.
On 1 Oct 2002, the billing methodology for MTF reimbursable services and procedures moved from an all-inclusive rate to itemized billing for outpatient services. Each outpatient encounter, service, procedure, or supply provided is billed as a line-item charged. The CHAMPUS Maximum Allowable Charge (CMAC) fee schedule and other government furnished rate tables are utilized for itemized charges.
All healthcare providers will document required information, based on current AMA and CMS documentation guidelines, pertaining to the patient encounter including services provided and procedures performed.
FREQUENTLY ASKED QUESTIONS ABOUT
Chargeable Visits
What is a chargeable visit?
According to DoD Instruction 6010.15-M Military Treatment Facility Uniform Business Office Manual, "pay patients are required to pay for visits that entail interaction between the patient and health care provider that involve evaluation management services and includes documentation in the medical record. Referrals or consultations are considered chargeable visits."
Will I be charged if I'm referred to another clinic?
Yes. If the initial clinic sees you and generates a chargeable visit you will be billed for that particular visit; if you are seen in a subsequent clinic, you will also be billed.
What if I go to the same clinic twice in the same day?
There will be a second charge if the second visit is not related to the first.
What if I go to several clinics on the same day?
Each clinic visited will result in an additional charge. If, for example, you are seen in Family Practice and then in Optometry, there will be two charges.
Will I be charged for a telephone consult?
No. DoD placed a moratorium for telephone consultations at overseas facilities. New prescriptions or changes in treatment plan will not be done via telephone consultation.
Is a follow-up visit chargeable?
Yes. However, there are a few exceptions. For example, if you have a follow-up for dressing change, or suture removal.
Can I find out how much a prescription will cost prior to picking it up?
Yes. If you would like to know the cost of your prescription prior to picking it up, please supply the name of the prescription, how many milligrams, and quantity to the Cashier's Cage. It is important to know once you sign for the medication, you are responsible for payment.
If the provider prescribes a medication and then asks me to come back in two days for a blood test to see if the medication is working, will I be charged again?
Yes. This is a follow-up where additional testing is done and is considered a chargeable visit.
What follow-up visits are non-chargeable?
Blood pressure checks, when requested by the physician as follow-up treatment
Follow-up visits for the sole purpose of checking bandages, dressings, sutures, and casts
Removal of sutures or cast. NOTE: Replacement of a cast is chargeable.
Other non-chargeable visits include:
Weight checks
Vision test for military drivers license
Pre-employment physicals if required for federal positions
Participation in diet counseling.
Participation in obstetrical orientation classes are not chargeable unless
medication or lab tests are prescribed, then it is a chargeable visit.
Participation in a Smoking Cessation class is not chargeable unless a prescription is written, and then the visit is charged at the clinic rate.
When a provider requests the presence of other family members to facilitate treatment of the primary patient, only the primary patient is charged.
Blood and alcohol tests performed at the request of security police or commanders
Job-Related Illness/Injuries - You must present a form CA-16 prior to treatment.
NAF employees use form LS-1 or LS-204. AAFEES employees use LS-202.
If my relatives come to visit me from the states, can they be seen at the clinic?
Only family members that are in DEERS are allowed to receive care on a reimbursable basis. If it's an emergency, they may be seen at the U.S. Naval Hospital Okinawa (USNHO) emergency room. If not, they will have to seek care on the local economy.
Insurance
As a pay patient you are responsible for your health care bill, however, if you have insurance coverage the cashier will bill your insurance company on your behalf.
Steps to follow to ensure proper billing:
1. Let us know if you have insurance by completing an insurance
worksheet. You must have the insurance card in hand. (Forms are provided to you at the cashier's cage).
2. Provide the Cashiers Cage with your current mailing address and phone
number.
3. If you want your insurance company billed, make sure you notify the
cashier. If you do not inform the cashier within 30 days of visit you will be responsible for paying the bill and seeking reimbursement from your insurance company.
4. If your insurance company changes, it is your responsibility to bring the
new insurance card to the Cashier's Cage. The 18th Medical Group will not send claims multiple times to your insurance company.
Will I receive a bill for the visit if my insurance company is directly billed?
It usually takes 17 to 20 days for the bill to generate in the Composite Health Care System (CHCS) from the date of your visit. The cashier's cage will send you a copy of the Invoice & Receipt (I&R) with a stamped message letting you know we have billed your insurance company. This is not a bill. When we receive payment from your insurance company we will then bill for any remaining balance.
When will I be responsible for payment?
If we have not received payment from your health insurance carrier within 60 calendar days you will be billed. In accordance to DoD 6010.15-M 7b paragraph 2, patients are personally liable for any amounts that are not paid by the insurance carrier within 6 months from the date the claim is filed. We ask patients to pay upfront and then contact their insurance company to find out why they didn't pay.
What if I make a payment and the insurance company pays later?
When overpayments are received the Cashiers Cage will refund the appropriate party.
How will I know when my insurance carrier has made payment and how much of the visit was paid?
You will receive an Explanation of Benefits statement from your insurance company stating payment amount and your out of pocket expense or responsibility. When payment is received we will send notification of payment and remaining balance due.
Are there any services that can not be billed directly to my insurance company?
Yes. We cannot directly bill insurance companies for dental services or Immunizations. Payment is due within 30 days and you must file for reimbursement with your insurance company.
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