Author Topic: New PI payment procedure  (Read 1430 times)


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New PI payment procedure
« on: March 17, 2011, 11:25:21 AM »
This is a new one (well at least to me).

We have a patient with an auto accident claim.  She has Med-Pay on her insurance (AAA).  We billed AAA as we always do using our normal fee schedule.  They sent the payment to the patient.

Luckily, this is an awesome patient.  She received the payment, cashed the check and came in and paid us. 

My question is this, since we billed the insurance company, but the patient is coming in and paying cash, can the patient negotiate a discount?  I'm guessing no, since we would have to offer the insurance company the discount, right?

My past experience with 3rd party claims allows for negotiation with the patient or the attorney after the case settles, based on the settlement amount.  But this circumstance is different.

I'm wondering if this is a new procedure for the auto insurance company to avoid having to send a 1099 to the doctor?

Any input is greatly appreciated!!!



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Re: New PI payment procedure
« Reply #1 on: March 18, 2011, 08:05:11 AM »
I think if you include a AOB (assignment of benefits) form they would have paid the provider directly.  I've seen many carriers require the AOB to pay the provider since the policy is the patient's (paid for by the patient) so they need permission from the patient to pay the provider. 

But, the answer to your question will vary depending on the state.  In NY, the provider must accept the NF fee schedule as payment, so the patient must pay you the fee schedule amount, which is what they should have received.  They shouldn't pay less because they are bringing in the cash. 

I believe in most states it would be a problem for them to get a discount for bringing in the cash.  But you should check the state you are in.

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