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Texas Department of Insurance
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Federal Military Treatment Facilities

The Texas Labor Code applies to services provided to injured employees at federal military treatment facilities (FMTF). With few exceptions, health care provided to an injured employee at an FMTF, on or after January 1, 2020, is paid at 100 percent of the billed charges.

What is a federal military treatment facility?

An FMTF is a medical facility that is part of the Military Health System of the United States Department of Defense. For example, Brooke Army Medical Center (BAMC) in San Antonio is an FMTF.

Applicable law

Information for workers’ compensation insurance carriers and certified health care networks

What are my responsibilities when processing a medical bill from an FMTF?

The insurance carrier shall pay or deny a medical bill from an FMTF no later than 45 days from receipt of the medical bill. The insurance carrier may only deny a medical bill for medical necessity, compensability, extent of injury, or liability reasons.

What amount should I pay an FMTF for medical services provided to an injured employee?

The insurance carrier shall pay 100 percent of the FMTF’s billed charges for medically necessary services related to the compensable injury. These charges may include any accrued interest, administrative penalties, or collection fees.

Where do I send a copy of the first medical bill from an FMTF?

Fax a copy of the first medical bill received from the FMTF to 512-804-4673. 

Why does DWC need a copy of the first medical bill from an FMTF?

DWC needs the first bill to identify the claim for future data requests, monitor billing and payment, and provide education to the insurance carrier and the injured employee as needed.

Can I deny a medical bill because it was not filed timely by the health care provider, it did not meet other medical billing or preauthorization requirements, or because the health care provider was out-of-network?

No. The insurance carrier cannot deny payment for these reasons. See Texas Labor Code §413.0112(c). The insurance carrier may only deny a medical bill for medical necessity, compensability, extent of injury, or liability reasons.

Can I deny a medical bill if there is an unresolved compensability or extent of injury dispute?

Yes. The insurance carrier shall file required notices within the timeframes specified by applicable laws and rules. See Texas Labor Code §409.021, and 28 TAC §§124.2 and 124.3.

Can I deny a bill for lack of medical necessity?

Yes. The insurance carrier shall comply with all the requirements and timeframes applicable to retrospective review for medical necessity. See 28 TAC Chapter 19, Subchapter U, 28 TAC 133.240 and 133.250.

Am I required to send an explanation of benefits when I process a medical bill from an FMTF? 

Yes. The insurance carrier shall issue an explanation of benefits to the FMTF when the insurance carrier makes a payment or denies payment on a medical bill. The insurance carrier shall also issue an explanation of benefits to an injured employee when payment of a medical bill is denied. See 28 TAC 133.250.

For more information, call DWC customer service at 1-800-252-7031, option 1.

For more information, contact: CompConnection@tdi.texas.gov

Last updated: 9/24/2020