FALLS CHURCH, Va. –
Recently injured? Whether it was a car accident or a slip on a wet floor, if someone else is at fault, federal law allows TRICARE to seek payment of your medical costs from that third party.
“Checking for third-party liability after an accident ensures proper billing coordination, compliance with the law, and that medical costs are covered by whoever is responsible. This process helps protect TRICARE’s resources, keeping it affordable for all beneficiaries,” said Latoya Hayes, claims subject matter expert, TRICARE Health Plan, at the Defense Health Agency.
Here’s what will happen, and what to do:
- When your doctor files a claim with your TRICARE plan, they use codes describing the reason for your visit. In some cases, a code may say how an injury or incident happened. These codes help identify when a third party is responsible for covering medical costs. Examples of third parties are:
- Auto insurance,
- General liability insurance, or
- An employer
- When your TRICARE regional contractor gets claims that may involve third-party liability, they’ll send you a Statement of Personal Injury – Possible Third Party Liability form (DD Form 2527) to fill out. You must fill in and sign this form within 35 calendar days.
- Follow the directions from your regional contractor to return the form to their claims processor.
- You may need a proof of insurance letter.
Where can I get care after an accident?
After an accident, don’t hesitate to seek
emergency care. Emergency care means care for an illness or injury that threatens your life, limb, sight, or safety. If you reasonably believe you have an emergency, always call 911 or your international emergency number. Or go to the nearest emergency room. If you need urgent care, go to an urgent care clinic. Make sure you follow your plan’s rules for getting
urgent care.
If you’re enrolled in a TRICARE Prime plan:
- Contact your primary care manager within 24 hours or the next business day after you get emergency care.
- Follow up with your PCM for a referral for any specialty care. This helps to avoid point-of-service fees.
What will it cost?
Cost-sharing under your TRICARE plan is the same, regardless of the cause of an injury. Visit
TRICARE Costs to view your health plan costs. If you have
TRICARE For Life coverage and live in the U.S. or a U.S. territory, you must also follow
Medicare’s rules for getting care, as described in the
TRICARE and Medicare Turning Age 65 Brochure.
How to get help
Contact your
regional contractor with any questions. Working with your regional contractor on third-party liability after an injury is one more step on the road to recovery.
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