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Thread: Auto related claims

  1. #1

    Default Auto related claims

    AAPC: Back to School
    If a patient is seen for an auto accident related issue and there benefits have been exhausted. Do you have to bill Medicare or any other health insurance for that matter. Is billing the health insurance for auto related charges a courtesy? Can you simply make the balance patient or attorney responsibility?


  2. #2


    If they have medicare you have to file the liability for 90 days if they do not pay you can file medicare. As far as commercial carriers go in our office it depends on each contract with the individual insurance so i would check there. Hope this helps

  3. #3

    Default MVA claim and Medicare

    In order for Medicare to pay the 8K must be exhausted - You must contact the auto carrier if the patient have more than 8k in coverage that also must be exhausted.
    You will need to obtain this exhaust docuemtation in writing from the auto carrier in order to bill to Medicare.
    The timeliness for billing to Medicare(or almost any carrier) is from the date on that exhaust letter.

  4. #4


    Thanks for the posts, but my real question is still not answered. Do you have to bill the patient's health insurance after the auto policy is exhausted?

  5. #5
    Join Date
    Apr 2007
    Murrieta, CA


    Yes you do bill the private insurance once the PIP/Med Pay is exhausted. Be sure to submit a copy of the exhaustion letter with your claim so the carrier does not deny due to 3rd party liability. If they still deny the claim, appeal it. They must pay once they recieve notification that the med pay is exhausted. Any claims submitted by any provider after the date of the exhaustion letter should be processed for payment.

    Hope that helps you.

  6. #6
    Join Date
    Apr 2007

    Unhappy Teri

    I believe that if you are contracted with the patient's insurance carrier you are responsible to bill the claim.

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