Wiki Balance Billing for Commercial/Auto

[kfrycpc]

Hello all,

If a patient signs the waiver to have her regular commercial insurance pay for procedures that resulted an injury due to an auto accident, and the commercial payer pays but there is a balance (coinsurance/deductible), can we bill the patient for that or can we bill the auto carrier, OR, is it a writeoff? I have a feeling the auto will reject it because the services weren't pre-authorized due to the waiver.

Please advise.

Thanks!
Kellie

 

[Lukelie]

I believe you would balance bill the patient following the rules of insurance billing. By signing the waiver the patient assumes responsibility after the carrier processes the claim.

 

[Leenahz]

I'd refer to your provider contract and/or provider representative. Our office was allowed to do something similar with one commercial carrier, but not with another. I understand the reasoning behind management wanting to collect a certain percentage up front, but personally, I have difficulty with it too. I try to look at it if I were in the patient's shoes, as should they, but hey, who am I?

 

[MarcusM]

Your are bringing up subrogation issues when you bill a commercial health insurance for a personal injury case like a MVA. Same thing with worker's compensation cases. The HCFA 1500 claim form has little boxes that ask if this is due to a MVA or work injury and a box for "date of injury" because the provider should bill those payers instead of the medical insurance. "Fraud is a false representation of a matter of fact?whether by words or by conduct, by false or misleading allegations, or by concealment of what should have been disclosed?that deceives and is intended to deceive another so that the individual will act upon it to her or his legal injury."