Location: First floor of the hospital

Hours: Monday through Friday: 7:30 a.m. – 4:00 p.m.

Phone: (912) 435-6037 or 435-5407

Services: By law, all military treatment facilities must bill private insurance companies (third party insurers) for the care provided to military family members, and retirees and their family members who have insurance. The Third Party Collection Program was established to seek reimbursement for care provided at Winn, and all Department of Defense medical treatment facilities.

You will need to verify if you have insurance during clinic visits and pre-admission interviews. The insurance company will pay the hospital directly and patients are not responsible for any uncollected charges.

All funds collected through this program are retained by Winn, and are used to enhance and expand medical services here on Fort Stewart. For the benefit of everyone, it is important to report your private insurance to the clinics or pharmacies you visit.

Third Party Collection Program Overview

Third Party Collection Program (TPCP) recovers funds from health insurance companies, other than TRICARE, for the cost of medical care delivered at our facility to insured patients. The program benefits both the patient and Winn.

In general, a TPCP patient is a retiree or a family member who is TRICARE eligible, but also has other health insurance like Blue Cross or Group Health, through their employer. This program does not apply to active duty personnel.

The TPC program:

• Does not effect the patient’s insurance premium
• Has no co-pay
• Has no cost to the patient for outpatient and ancillary services. Charges for inpatient stays may apply.

Third party health insurance is coverage that the patient and/or spouse may be paying for, but not using. When you don’t use it, the only one who benefits is the insurance company. We use the funds to enhance care, upgrade equipment, and maintain services at Winn.

Frequently Asked Questions

What effect will this program have on my health insurance? None. Health insurance is intended to cover you and your family’s needs for the medical services listed in your policy based upon the premiums patients and their employers pay for those services. By providing policy information to Winn we are able to collect the cost of healthcare, thus the insurance is being used exactly as it was designed. Health insurance premiums, unlike automobile insurance premiums, typically do not increase due to treatment/hospitalization. Instead, they are usually determined by calculated statistical risk data based on an entire insured group. This means that under most circumstances, a patient’s medical insurance rates will not be affected.

Where does the money go? Payments from healthcare insurance companies go directly to Winn. These funds are used directly to enhance healthcare services to our patients.

If the full cost of care is not collected, will I get a bill from the hospital or my insurance company? No. Patients will not be billed for any costs that Winn is unable to collect on outpatient and ancillary services. Patients will receive an Explanation of Benefits (EOB) from their insurance company. The EOB will explain how much was paid to Winn and what deductibles or co-payments were subtracted from the claim filed by the Third Party Collection Program. The EOB is not a bill – it is merely an explanation for the patient’s personal records. The patient is not responsible for co-payments or deductibles not paid by their insurance companies, even if they appear on the EOB. Inpatient charges may apply if no payment was received on a patient admission.

How will each patient’s deductible be affected when billing insurance companies?
Most insurance plans have a deductible that must be met before the plan starts to pay. When Winn files claims, the amount billed may be counted toward the patient’s deductible. As a result, the patient will actually spend less money out of pocket when civilian treatment is rendered.

What are the legal aspects of the Third Party Collection Program? The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) established the Third Party Collection Program. Under this federal program, military treatment facilities are authorized and obligated to bill health insurance carriers (i.e., Blue Cross or Prudential) for the cost of medical care furnished to military retirees, their dependents, and dependents of active duty who are covered by health insurance policies. Laws also provide for a fine of $10,000 and five years in prison for not disclosing insurance information. Winn, as a military treatment facility, must comply with these laws and depend on our employees and patients to help make this program a success.

Do patients need to provide their insurance information with every visit? To collect benefits covered by each patient’s health insurance, Winn must verify information that appears on the patient’s health insurance identification card. Patients should ensure their insurance information has been provided/updated and must have an updated DD2569 on file annually.

What if the patient receives payment from the insurance company for healthcare received? Payments received in error for healthcare should be forwarded to the Hospital Treasurers Office at Winn.

Will not having medical insurance have any affect on the patient’s healthcare received at Winn? Having Third Party insurance has no direct relationship with the care and entitlements patients receive at Winn. There will never be a negative effect on a patient’s treatment.

We Can Save You Money – Here’s How

We can help you meet your annual deductible, so when you use your private health insurance at a civilian provider, those out-of-pocket expenses may be partially or fully paid.

• When you see a civilian provider and use your private health insurance, most insurance plans have an annual deductible – leaving you with out-of-pocket expenses, however…
• We can help you meet this cost.
• When we bill the insurance company for your visit at Winn, your deductible is subtracted from the amount we billed. In other words, we absorb the deductible for you.
• So, when you use your insurance in the future at a civilian facility, your out-of-pocket costs may be partially or fully met.

All you need to do is inform us of your health insurance information and we’ll do the rest. You will be providing yourself and Winn a significant benefit.

Keep in mind that…

• Your premiums will not be affected.
• There is no cost to you for outpatient and ancillary services regardless of the insurance company’s claims processing. In other words, if the insurance company does not cover the entire cost, we will not send you a bill for the remainder.
• If no payment is received for an inpatient stay, however, charges may apply.
• Health Insurance premiums are NOT like car insurance. They do not rise simply because you use it. Health insurance is generally based on the risk of the entire group of insured patients, not the individual.

Explanation of Benefits (EOB)

You will receive an Explanation of Benefits (EOB) from your insurance company. Do not be alarmed.

An EOB Is Not A Bill. It is simply an explanation for your records. It will state what was charged for your visit and how much was paid. Again, there is no cost for outpatient and ancillary services, however, inpatient charges may apply. Feel free to contact us with general questions regarding an EOB you receive.

Legal Requirements and Authority

We are required to perform this function under the Consolidated Omnibus Reconciliation Act of 1986 (COBRA). Under this program, Military Treatment Facilities are authorized and obligated to bill health insurance carriers (like Blue Cross, etc.) for the cost of medical care furnished to retirees and family members that are covered by health insurance policies. Winn must comply with this law, and requires everyone’s support to make this program successful.

Additionally, beneficiaries are required to disclosure third party insurance by law. Again, the TPCP is a cooperative effort, which requires staff and patients to make it successful.