Wiki Auto accident billing vs health insurance

[cwilson3333]

I don't know the ins and outs of billing auto insurance versus billing the patient's health insurance who we are contracted with and would like some input.

Let's say we bill the health insurance, and do the contractual write-off.

Patient then requests we submit to his auto insurance and that patient receives full reimbursement of the charges submitted. Is is legal to then bill the patient for the write-offs that were required by our contract with the health insurance?

We normally don't want to get involved with the auto insurance, because 2 things usually happen: The patient gets paid directly, and doesn't pay the doctor. Or the claim gets tied up in court for a couple of years, so we just have to wait for reimbursement.

Would like to know how other offices handles this situation.

Thanks
WC

 

[Birdie625]

Chiro Auto/private

I do some billing for a DC and my opinion is...you should know if pat. coming in for inj. 'caused' by auto accident, you should bill the auto claim 1st...IF you dont want to deal with such, then have the patient pay up front, give them statement of charges, send them on their way. If i were faced with a situation like this and billed their personal ins. 1st (because they didnt state what caused inj.), I would make sure their statement showed how much the patient paid OOP...as to me that should be the only amt they would be entitle to.

ANSWER to Q: I would say not legal to collect WO amt...that is what you all agreed to...sounds like the patient is a little 'sketchy'..as they should not have rcvd anything and THEY should pay their personal ins back for what they paid out or return $$ to auto...

this is not how we do in our office as we deal with the auto ins, etc...

My above statement is how I would do it if we had a situation as such....but again, when we get new patients calling for appt. I ask, is it related to WC or auto...and even existing patients with new complaints....if they tell us, "Oh, I was in car accident..." we have to get the auto ins info and bill that ins 1st..

 

[kvangoor]

I would refund the health insurance and bill the auto the full ammount. They will probobly pay the full ammount and then you would not have this delemma. If the health insurance finds out it is due to a car accident, they will want to pay secondary, if at all, depending on the plan.

 

[mitchellde]

This is why you use the E codes on the claims for accident and injury. If you used the E code for auto injury and bill to commercial ins they will likely reject it but it does depend on the state you are in and whose fault the accident is.

 

[LLynn29]

Always verify with the auto carrier that there is a claim number before filing the claim and check with both carriers to see who is primary and secondary. Sometimes, there are circumstances when the health insurance carrier is primary over auto. Auto billing has it's rewards, but if it's not done right the first time, it can take a long time to straighten it out.

 

[domaha28]

NoFault

I am in New York. We see no fault patients. We have had patients come in and not tell us their problem was due to a no fault accident. That led to us being paid by the health insurance, then have to refund payment and try to get the no fault information from the patient to bill the proper insurance. Now the patient is asked when they make an appointment if it is related to no fault or workers comp and they must have all the information before they are seen. There is also a form they sign that goes with the claim that permits us to receive payment directly from the insurance company. Saves ALOT of headaches!!