Wiki car accident billing

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khristinelouise

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I had a patient come in to our urgent care today who wanted to be seen for injuries sustained in a car accident. She said she didn't intend to open a claim with her auto insurance and wanted us to bill her medical policy. I explained that we only accept cash payment for car accidents because their medical insurance may not pay for the claim. She then said it was none of her insurances business how she got injured and we should just not tell them that it was due to a car accident.

I have also recently had a similar problem where someone was injured at work but didn't want to open a workmans comp claim and instead just wanted us to bill their medical insurance.

My boss says they have the right to do this. I could really use some imput please:)
 
You can file the claim to the medical plan, but you cannot 'just not tell them' that it was due to an auto or work-related accident. I would explain to the patients that if the medical record reflects that the injuries were related to an accident, then you will need to indicate this on the claim form (in box 10), and that in order to file the claim you will also have to provide the insurance company with ICD-10 diagnosis codes that will reflect the nature of the injuries. It would be a false claim to do otherwise, so you cannot legally conceal that information from the insurance companies. You might also let them know that once you file a claim, the insurance company have the right to request and review the medical records. It absolutely IS the insurance's business to know how the patients were injured if they are the ones being asked to pay for the treatments. If the patients truly do not want the insurance company to know how they were injured, then they should be paying for the services out of pocket and not asking you to file a claim.
 
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