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Thread: Help!!!

  1. #1
    Join Date
    Apr 2007

    Question Help!!!

    AAPC: Back to School
    Do you know if most health insurance companies will pay for a patient's fingers smashed in a car door? Or a patient that is injured in a non moving vehicle? I thought as long as there was no collision most health insurance companies will pay...

  2. #2
    Join Date
    Apr 2007
    Kansas City, MO


    I'm pretty sure they'll want records, but I dont see why they wouldn't pay once they saw it was no one elses fault...like smashing your hand in a door at home, or getting your fingers caught in an electric mixer...but I dont know who would ever do something dumb like that
    Linda Vargas, CPC, CPCO, CPMA, CPC-I, CEMC
    PMCC Licensed Instructor
    Kansas City, MO Chapter
    Member Development Officer 2016
    Harrisonville, MO Chapter President - 2013
    ICD-10 Education Coordinator- 2012
    Chapter President - 2011
    President Elect - 2010

  3. #3


    Back when I was in New York, anyone who was injured by a vehicle, whether moving or not, had to submit the bills to the auto insurance carrier. Anyone who was injured in a fall even in their own home, would have to submit the bills to their homeowners policy and if they were not a homeowner, then their private insurance became responsible. Of course, if they were renting an apartment or a house and had renter's insurance, then the bills went there. If you were visiting a friend, etc., and had an incident in their home, then their homeowner's or renter's would be the primary payer.

    Not sure how it works today...in any state...with the turmoil in the economy.


  4. #4
    Join Date
    Apr 2007
    Milwaukee WI

    Default Injury claims

    Almost all claims with a diagnosis that is an injury are denied for "additional information" or "coordination of benefits."

    This means that the insurance company to whom you sent the claim needs information from the patient about what other insurance might be responsible.

    What we do in our office is immediately contact the patient and explain that if their health insurance will not cover the injury they will be responsible for all charges themselves. That usually gets them going on responding to insurance inquiries/letters about other possible coverage.

    A lot of people do not want to bill to their auto or home insurance because a claim might raise their insurance rates. But when the choice is self-pay or file with the right insurance (i.e. auto or home), they usually get us the accurate info pretty quick.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC
    Last edited by FTessaBartels; 03-23-2010 at 02:30 PM.

  5. #5
    Join Date
    Apr 2007


    You could try contacting the health insurance and ask if they would consider that an auto related accident or not.

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