Author Topic: Medical Facility is participating with an insurance company  (Read 1167 times)

nancimartinct

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Hi I'm new to the board - My name is Nanci - I was wondering if anyone knows the answer - A payment was made to a medical facility for a person's treatment following an automobile accident by their medpay portion of auto insurance. It appears that they were a participating facility with the insurance company and the insurance company took a discount before making a large payment. Now there is a collection agency coming after the patient for a balance due - is that allowed? By the way I'm in CT so I don't know where everyone is - but I thought if the medical facility was a participating facility with the insurance company (it is called CorVel - CorCare - insurance co is The Hartford) they automatically write-off any balance left after they've agreed to accept payment from the auto medpay policy. Right or wrong thinking? Thanks

DMK

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Re: Medical Facility is participating with an insurance company
« Reply #1 on: May 20, 2010, 04:32:41 PM »
My understanding is that if you're participating or in their network, you agree to take the allowed amount and write off the balance.

I have run across many more auto and worker's comp policies who are now connected to other review companies (CorVel is one, United HealthCare is another, Blue Cross comes up a lot for us).  So your provider may not even realize they are "in network".  Research should be done to see how it's all connected for your office.

Your office should have all their facts in order before the sic the collection agency on the patient.

Also, when it's an auto accident, different rules apply.  If you're truly non-network, contact the insurance company and try to get the balance paid.  If they won't, and you are non-network, you can always have the patient sign a lien against the final settlement.

Michele

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Re: Medical Facility is participating with an insurance company
« Reply #2 on: May 20, 2010, 08:29:20 PM »
In order to be sure you could call the insurance carrier and ask if the provider is in network, and ask them what the patient should be responsible for. 

Michele
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