Results 1 to 3 of 3

Billing pt medical policy for personal injury

  1. Default Billing pt medical policy for personal injury
    Medical Coding Books
    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
    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. Default
    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.

Similar Threads

  1. Medical Practice Coding & Billing Policy
    By AuditU in forum Auditing General Discussion
    Replies: 0
    Last Post: 05-01-2014, 02:50 PM
  2. Medical Records Dept. Policy and Procedures Manual
    By jobij in forum Compliance General Discussion
    Replies: 1
    Last Post: 10-08-2013, 02:12 PM
  3. Blue Shield of CA medical policy
    By ramzeee68 in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 09-16-2013, 02:53 PM
  4. Medical Billing Policy and Procedures
    By heatherirene19 in forum Compliance General Discussion
    Replies: 0
    Last Post: 11-12-2012, 01:54 PM
  5. Auto/Personal Injury Billing
    By in forum Billing/Reimbursement
    Replies: 1
    Last Post: 12-29-2011, 12:35 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.