Author Topic: Who to bill? Health insurance or PIP  (Read 1012 times)

2012billingrep

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Who to bill? Health insurance or PIP
« on: February 03, 2012, 04:17:11 PM »
A patient was treated for a few visits in a chiropractic office and health insurance was being billed. Patient then says he had had an accident just prior and feels the pain etc is due to the accident. Patient now wants to use PIP. He had made a police report and has a claim number.  Do I send the claims from the beginning of treatment and any future treatments to the patient's auto insurance?  The patient was told by his auto insurance that he has a $1000 deductible. He is wondering why he has to pay this if he was not at fault and the other auto insurance is covering expenses for his vehicle damage.  I believe this deductible is part of his policy? He was also told that the auto insurance company of the person at fault would collect all the claims and offer him a settlement. Is this routine? Am I able to send the claims directly to the auto insurance of the person at fault and not the patient's auto insurance?

The patient also has a deductible of $800 with his health insurance which he has not met. Can the patient opt to go with one insurance over the other based on the lower deductible or must PIP be billed if injuries sustained were caused from the accident? Would health insurance not deny the claims?

Appreciate any help here! Am new to billing PIP.




PMRNC

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Re: Who to bill? Health insurance or PIP
« Reply #1 on: February 04, 2012, 07:36:21 PM »
No he can't really make that decision himself, and actually this is outside of scope of what you should be doing. You need to bill accordingly with proper diagnosis and accident information, the situation with his deductible is between him and his carrier.  You should probably contact the PIP carrier and see if they have an open case, obtain proper verification and info needed and bill them.  If claims get sent to health insurance carrier first they are going to deny for accident or third party recovery anyway as the PIP would be primary. Some indeed can use their health insurance carrier as secondary.
Linda Walker
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