Personal Injury Claim to Medical insurance also?

[dfranklin]

If you have a patient that has a PI (Personal Injury) claim to say GEICO or State Farm etc for a motor accident and the patient also has medical  coverage by BCBS and a secondary Medical Mutial of Ohio, do you submit to GEICO as a primary and then to BCBS as secondary and Medical Mutal as tertiary? Or because it is an auto accident you can only submit to GEICO and the unpaid amount is patient responsibility and you can't submit to their medical insurances?

Thanks!

Don

[Michele]

Usually NF, or PI claims pay 100% of the allowed amount, so there is no patient responsibility.  The only time I have billed their major medical after a NF or WC is if the case is apportioned.

Michele

[dfranklin]

I think it is PIP (sometimes it is hard for me to know if I am billing a PIP or PI claim) but I don't think PIP pays out at 100%.  So when PIP is involved like State Farm they pay well but not at 100%, do I then bill regular medical insurance primary and secondary (if they have it)?

Thanks!

[DMK]

I've had experience with this both professionally and personally.  Here in California, many attorneys are having patients use their health insurance 1st (to get the contractual discount) then using their Med Pay 2nd.  Bad for the doctor, good for the patient if they have limited Med Pay on their auto policy.  Insurance companies are also having people drop their Med Pay entirely if they have health insurance.  (Med Pay is such inexpensive insurance I would encourage people to get as much as they can afford.)

If it's a 3rd party claim (the other person is at fault and their insurance will pay at the end of the claim) the doctor should bill their health insurance if they can so that they're paid in a timely manner.  Lots of 3rd party claims don't pay the doctor, they pay the patient, then the patient doesn't pay the doctor!

This may seem rambling, and ultimately you have to bill who the doctor tells you to, but as a biller you need to be aware of the many scenarios there can be.  The doctor deserves to be paid for his or her services, and the patient should get their care, so get all the insurance info you can so somebody pays!

Dina

[PMRNC]

IF the patient has a rider they can use their health plan as secondary and in some states primary. You have to contact the auto carrier to determine if the patient indeed has this rider.