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Thread: Billing pt medical policy for personal injury

  1. #1

    Default Billing pt medical policy for personal injury

    AAPC: Back to School
    I work in a pain management center and we have alot of personal injury cases due to auto accidents, falls on personal property ect. Is it legal to bill their primary medical policy for these. The attorneys want us to bill their ins companies and then they settle the balances however, when the ins companies see that it was an accident they take back their payments. Is it fraudulent to submit them to the medical ins to begin with?

  2. #2
    Join Date
    Apr 2007
    Rapid City, SD


    I haven't ever seen anything that it is not legal to bill health insurance for an accident related injury. Of course if there is a 3rd party payor that should be responsibile for the care such as auto insurance or work comp, they should pay. I have seen numerous situations where the med pay on an auto policy is exhausted & you are left with no choice but to submit to patient's health insurance. The health insurance could then choose to pay or not to pay. The patient & their attorney would then be fully aware of attempts to the bills paid for.

    If there is a legal precendent regarding your question, I have never seen it in my 20+ years in the industry.

    Hope this helps

    R Hedges

  3. #3


    I like to bill the pts health insurance for timely filing and for denials if there is not enough information to bill auto/work comp. Then, the insurance will deny and you can go from there. Most PIP coverage is $4,500.00 and that can exhaust in one trip to the ER. You would need to file with auto in this case to get the PIP exhaust letter and then refile to health insurance for reconsideration of payment.

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