INCREASE

THIRD- PARTY
Group members:

Pacleb, Alvin John

Pre, Bea Louise
Quintua, Zharienelle
Tamayo, Shaina Angela
DIFFERENCE BETWEEN FIRST
PARTY, SECOND PARTY, AND
THIRD PARTY
 First Party
INDIVIDUAL RECEIVING THE SERVICE
PAYS HIS OWN BILL

Second Party
THE INSTITUTION PROVIDING SERVICE
COVERS THE BILLS OF THEIR PATIENT

Third Party
AN ORGANIZATION PAYING FOR THE
PATIENT’S MEDICAL BILLS
THIRD PARTY
ORGANIZATION THAT PAYS BILLS ON THE SERVICE PROVIDER ON BEHALF OF
THE PERSON RECEIVING THE SERVICES.
COMMONLY SEEN IN A HEALTH CARE CONTEXT, WHERE A PATIENT RECEIVES
TREATMENT AND AN INSURANCE COMPANY PAYS THE SERVICE PROVIDER.
REFERRED TO AS PRODUCT PAYMENTS.
PEOPLE MAY REFUSE TO ACCEPT THIS COMPENSATION METHOD.
THE THIRD PARTY MAY ALSO REFUSE IF THE SERVICES ARE NOT COVERED.
REQUIRES PREAPPROVAL IF THE CLIENT IS ELIGIBLE OR NOT IN RECEIVING A
SUPPORT FROM A THIRD PARTY ORGANIZATION
Advantages of using third-
party services
COVER PATIENTS’ MEDICAL COST
PROVIDE ACCESS TO PREVENTIVE MEDICINE
PROVIDE ACCESS TO HEALTH CARE SERVICES
PROTECT PATIENTS’ INTERESTS
SHIELD PROVIDERS AND DECREASE PAYMENTS UNCOLLECTIBILITY
HELP TO ADVANCE HEALTH CARE SERVICES
disadvantages of using
third- party services
UNAFFORDABLE PREMIUMS DUE TO PRE-EXISTING HEALTH
CONDITIONS
DOES NOT GUARANTEE COMPLETE ACCESS TO CARE
SOME INSURANCE COMPANIES EXCLUDE IMPORTANT MEDICAL
TREATMENT.
YOU MAY STILL HAVE TO PAY A FRACTION OF THE OVERALL COSTS
Third- party payers
Third party payer is anyone who pays
for medical services other than the
patient.
Most common third-
party payers:
1. HEALTH INSURANCE

AN AGREEMENT IN WHICH AN INSURANCE COMPANY

AGREES TO PAY FOR SOME OR ALL OF YOUR MEDICAL
EXPENSES IN EXCHANGE FOR A MONTHLY PREMIUM
PAYMENT.
examples:
PhilHealth (Philippine Health Insurance
Corporation)
HMO (Health Maintenance Organizations)
Prepaid Health Cards
Private Health Insurance.
 Most common third-
party payers:
2. MEDICARE OR MEDICAID

FEDERAL HEALTH INSURANCE FOR PEOPLE 65 OR

OLDER, SOME YOUNGER PEOPLE WITH DISABILITIES,
PEOPLE WITH END-STAGE RENAL DISEASE.

EXAMPLES:
MEDICARE PART A
MEDICARE PART B
MEDICARE PART D
WHO IS ELIGIBLE FOR THIRD
PARTY PAYMENTS?
Out-patient or in-patient psychiatry or psychotherapy, including emergency mental
health services.
Medical treatment. Depending on the payer, this may include anything from major
surgery to administering medication.
Preventive health maintenance, such as a weight-loss group or a child nutrition class,
may also be funded as medical treatment.
Elder services, such as home health care
Independent living facilities and support for a number of groups, including the mentally
ill, retarded adults
Physical therapy
Thank
you