Q:

A current patient in our clinic in Georgia just had an automobile 

accident.  He doesn't have MedPay.  He doesn't plan on using an attorney but 

does plan on seeking a settlement after MMI.  Knowing the gamble at hand, we 

plan on waiting for any settlement.  However, in the meantime, can we bill his 

health insurance company for care and are they likely to pay even though it's 

for an MVA?


A:

Thanks for your e-mail. As far as the PI case. You have five choices for payment. Medpay 
(patients auto insurance pays you directly) .. Third Party (insurance that caused accident) .. 
Attorney .. Health Insurance .. Cash. Each have different degrees of success and ease. 
Medpay is best as it pays 100%. Third party is second but payment is after the fact and not 
assured and patient can get the check and run .. Attorney should protect your fees but often 
they want to cut and negotiate with you if settlement is low .. Health Insurance is a 
possibility but depending if it is a managed care program (HMO/PPO) payment may be less 
and number of visits may be restricted (although you may be able to request balance once 
settled but problem may be patients that feel their health insurance should cover 100% and 
refuse to pay any balance or insurance company request you don't) .. Cash is best but 
restricts your services due to prohibitive fees.

So .. your question was using Health Insurance. This is what we do. We call and verify 
coverage from the Health Insurance carrier and specifically determine if we can bill for a 
auto injury and if we can bill the patient the difference between the fees they pay and the 
remainder of the bill not paid. Some say fine others say no. Some carriers will not pay for 
an auto injury unless there is proof the patient has no medpay (we always patients request 
their personal auto insurer fax us a letter that they have no medpay coverage) and often this 
letter with the claims helps get the bills paid by a Health Insurance carrier. So .. yes .. you 
can bill the Health Insurance for the care if they allow and I would make it clear to the 
patient that once they settle with the third party carrier they will reimburse the difference 
and be sure they know the bill before you release them.

I hope this helps

Dr. M