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  4. HFS 2875 Medical Assistance and Third Party Liability

HFS 2875 Medical Assistance and Third Party Liability 

 

The Medical Assistance and Third Party Liability brochure explains how medical assistance works with other groups, known as third parties, to pay your medical bills. It will help answer many of your questions about which bills medical assistance will pay and which bills other resources pay. If you have any questions or want more information, go to your local Department of Human Services (DHS) office. If you do not know where your local office is or you are unable to go to there, call:

Illinois Department of Human Services
Bureau of Customer Inquiry & Assistance
Monday – Friday (except state holidays) 7:30 a.m. - 7 p.m.
Toll-free 1-800-843-6154 or (TTY) 1-800-447-6404

If you have questions about a third party resource resulting from a child support order, you can call:

Illinois Department Healthcare and Family Services
Customer Service Call Center
Toll-free 1-800-447-4278 or (TTY) 1-800-526-5812

What is Third Party Liability?

Third Party Liability means that a "third party" - not medical assistance and not you - has or may have a responsibility to pay all or part of the cost of your medical care. A third party may be another person, an insurance company, an organization or a program.

The Medical Assistance Program pays for your health care costs when no third party resource is responsible to pay for them, or when the third party resource will not pay enough of your medical bills.

Examples of Third Party Resources that may pay your medical bills:

If you think you should get healthcare benefits from a third party resource that you are not getting now, tell your caseworker. Your caseworker will tell you how to apply for these benefits. If I get Medical Assistance and have Third Party Resources, what are my responsibilities?

Tell DHS about your Third Party Resources

You must tell DHS about medical benefits you receive or should receive. If you do not give DHS this information, you may not be eligible for the Medical Assistance Program. Your children who are eligible for the Medical Assistance Program will continue to receive it whether or not you cooperate.

If your third party coverage changes or if family members are added to or deleted from the coverage, you must tell your caseworker within five days. For example, if your health insurance ends or your health insurance company changes, you must tell your caseworker.

Get free health insurance coverage if your employer or union offers it

If you can get free health insurance coverage (for you or you and your child who receives medical assistance) through your job, union or other organization, you must apply for it.

Turn payments over to DHS that you receive for medical services

If you receive medical assistance and you get money from a third party resource for a medical service that medical assistance already paid money for, you must repay the state of Illinois. Sometimes medical assistance pays a medical bill that a third party resource should have paid. When this happens, medical assistance has the right, by law, to collect its payment from the third party.

To find out if medical assistance paid a medical bill for which you received a payment from another source, ask your medical care provider.

Utilize Your Third Party Providers

You must see doctors who are network providers for your third party resource.

If I or a member of my family have a serious illness and I can enroll in a health insurance plan through my work or union, but I cannot afford the premiums, will Medical Assistance pay the premiums?

People with a serious illness receiving medical assistance may qualify for medical assistance payment of health insurance premiums if:

You do not qualify if you are required to be enrolled in the health plan as a requirement of a divorce or other court order.

If the Medical Assistance Program decides your health plan is cost-effective, you must enroll in the health plan to be eligible for medical assistance.

If I give DHS information about my health insurance or other Third Party Resources, will I still get a medical card?

Yes. As long as you are eligible for the Medical Assistance Program, you will receive a medical card. Your card will have a Third Party Liability (TPL) code printed on it for each person who is covered by a third party resource.

What does the TPL code on my medical card mean?

The TPL code lets your doctor, hospital or clinic know that there is a third party that may be responsible to pay for all or part of your medical care.

For more information on Third Party Liability or other DHS programs:

Call or visit your local DHS office. A caseworker at the office will answer the questions you have. If you do not know where your local DHS office is or you are unable to go to the office, call:

Illinois Department of Human Services
Bureau of Customer Inquiry & Assistance
Monday – Friday (except state holidays) 7:30 a.m. - 7 p.m.
Toll-free 1-800-843-6154 or (TTY) 1-800-447-6404

For answers to your questions, you may also write:

Illinois Department of Human Services
Bureau of Provider Assistance & Correspondence
100 South Grand Avenue, East
Springfield, Illinois 62762