#9 Are there any problems that can arise for my patient, if I bill their health insurance?
QUESTION: Are there any problems that can arise for my patient, if I bill their health insurance after a car accident?
ANSWER: If your patient has exhausted their PIP benefit and you’re considering billing their health insurance, your patient should check to see if their health insurance policy has what’s called a “futures penalty clause.” If there is this type of clause in their contract it can create problems for them in the future. What that clause means is that if the health insurance company pays for any medical care related to a car accident, when the health insurance company is reimbursed for the medical bills that they paid out for your patient, they will not pay for future medical treatment related to your patient’s body parts that were injured in the collision.
Are there any problems that can arise for my patient, if I bill their health insurance after a car accident?
If your patient has exhausted their PIP benefit and you’re considering billing their health insurance, your patient should check to see if their health insurance policy has what’s called a “futures penalty clause.”
If there is this type of clause in their contract it can create problems for them in the future.
There are two primary health insurance providers in Oregon, Providence, and Moda, that always have this clause in their policy contracts.
What that clause simply means is, if the health insurance company pays for any medical care related to a car accident, when the health insurance company is reimbursed for the medical bills that they paid out for your patient, they will not pay for future medical treatment related to your patient’s body parts that were injured in the collision.
As an example, if your patient has a neck injury from an auto accident and their PIP benefits become exhausted. You then bill your patient’s health insurance for the treatment you provided, and your patient’s claim is settled — their health insurance company will be paid back. Then, after their settlement, your patient needs more care and treatment for their neck. If your patient has either the Moda or Providence Health Plan, the insurance company will not pay for future medical treatment on your patient’s neck — until your patient can prove they’ve spent the settlement money they received for their medical treatment.
The important consideration and question to ask is if it’s more likely that your patient will need future medical care on their neck — if so, you will want to be cautious in billing your patient’s health insurance — especially, if you anticipate they may need injections or surgery.
If your patient was injured in a motor vehicle collision and their PIP is depleted — before you bill their health insurance, we strongly encourage healthcare professionals to consult with an experienced personal injury attorney.
Most lawyers are happy to talk with healthcare professionals to help them assess the potential risks of billing their patient’s health insurance for treatment related to an auto accident.
We’re here to be a bridge of support for you and your patients.
We have developed a robust library of information for your patients who have been injured in an accident, which can be found in the INJURED? START HERE portal on our website.
There are 40 topic-focused articles, with accompanying videos, organized into the four categories that include the personal injury claim-related questions we’re asked most often, which include:
- Top 10 Personal Injury Claim Mistakes to Avoid
- What You Need to Know About Your Claim
- How Are My Medical Bills & Wage Loss Paid
- How to Prepare for Your Independent Medical Exam
Each article provides advice and guidelines to help your patients navigate each phase of the personal injury claims process. Whether we represent your patient or not, we are passionate about them knowing how to protect their rights, get the medical care they need, and avoid the mistakes that can harm their personal injury claim.
Each article provides advice and guidelines to help your patients navigate each phase of the personal injury claims process. Whether we represent your patient or not, we are passionate about them knowing how to protect their rights, get the medical care they need, and avoid the mistakes that can harm their personal injury claim.
Additionally, if it would be helpful to have the information we feature on our website available in your office to pass along to your patients, we’ve developed brochures for each of the four article series -- in both English and Spanish that we’re happy to send to your office. Please complete the form below and we’ll get them out to you promptly.
