Wiki Help with Emergency Orthopaedic Trauma

[pmogel]

Need some help....new to emergency medicine and ortho. Here's a scenerio:

Orthopaedic Trauma surgeon is on-call for a hospital. Patient is brought in by EMS with multiple fractures in multiple areas due to a motorcycle accident. The ortho treats the patient and bills the insurance. Here's the issue....ortho is not contracted with patient's insurance. Insurance denies for that reason. I seem to remember a way to code a service as being provided on an emergency basis. Any thoughts?

 

[freemacl47]

er service non par with insurance

i would check for liability insurance involvement or if any motorcycle insurance as well and see if any claims filed with them and if paying for services or waiting for settlement. otherwise i would argue with the insurance stating that it was an emergenct situation. the insurance should have in their plan on how emergent situations are paid and when no par provider is available to care for the patient.

 

[stacy]

your place of service would be ER and you would think that they would see that. I would make a phone call to the insurance,or check into the insurance to see if there was any coverage. If that person got hit by someone else,,it goes on that auto insurance.