What Is TPL?

The hospital bills of many patients are paid by Third Party Liability insurance providers.

TPL in the insurance industry stands for "Third Party Liability" carriers, or insurance companies responsible for paying the initial and largest amount of a Medicaid patient's health care bills. A patient is ultimately the one to be held accountable for ensuring payments to health providers, but low-income individuals can qualify for insurance assistance through the federal Medicaid program. In some cases, a private insurer or one secured through the patient's employer is also obtained for insurance coverage; such carriers are referred to as "third party."

Law

In the U.S., Medicaid is the insurance payer of "last resort;" therefore, if a patient has other insurance coverage, that carrier is liable for and must make the initial payment on any health-related billings. State agencies that administer the Medicaid program have the option of paying after other insurance carriers or paying in advance and then using collection methods to seek reimbursement from TPL carriers.

Types

TPL carriers can be private insurance companies; companies secured by employers who then offer coverage benefits to their workers; the government Medicare program; liability providers responsible for payment of legal judgments or settlements; or companies secured as a result of a court order to a non-custodial parent for coverage when their child is under the guardianship of another adult.

Oversight

The Centers for Medicare and Medicaid Services is responsible for running the Medicaid program, setting policies including those related to TPL carriers, and for monitoring each state's adherence to federal regulations.

Requirements

Prior to acceptance to a Medicaid program, state agencies require potential recipients of government insurance benefits to sign documents agreeing that the agency is to receive any payments or benefits from TPL carriers. Refusal to these conditions renders an applicant ineligible for Medicaid benefits.

Carriers

Cigna, Blue Cross/Blue Shield, Farmers, Humana, Great West and Kaiser are major insurance companies commonly used as TPL carriers that regularly pay out benefits in advance of a patient's claims being submitted to Medicaid for payment.

References

• Third Party Liability Overview
• TPL Fact Sheet
• Oklahoma TPL Carriers

Resources

• District of Columbia TPL for Payment of Medical Expenses
• Minnesota Third Party Liability