tierspayant

Tiers payant is a payment arrangement in healthcare in which the payer covers the cost of care directly to the service provider, so the patient does not pay the full amount at the point of service. The patient may still owe a small co-payment if not fully covered, or nothing at all if the service is entirely covered by insurance.

In practice, the system relies on the cooperation of health insurance schemes, such as a national health insurance and any complementary insurers or mutuals. The healthcare professional submits the claim to the payer, who verifies eligibility and pays the provider directly. The patient presents proof of eligibility, for example a health card, and is spared upfront payment for covered services. When a mutuelle or supplementary insurance is involved, it may cover the remaining portion of the bill or the patient may be billed only for non-covered elements.

Two common forms are conventionné and non conventionné tiers payant. In the conventionné form, providers participate in an agreement with the national health system to apply the tiers payant for eligible services; the patient is relieved from paying at the counter for those services. In the non conventionné form, some providers may opt into direct payment arrangements outside the formal agreement, with reimbursement handled differently.

Tiers payant is widely used in several healthcare systems, most notably in France, and affects how patients experience access to care, cost-sharing, and reimbursement timing. It aims to reduce upfront costs but requires robust administrative processes to verify eligibility and process payments. See also: health insurance, mutual insurance, ticket modérateur.