Have you ever been involved in an auto accident only to find that the doctor you want to see won’t bill the at fault party’s insurance company. This happens more than you think it would. Many doctors including your PC don’t like billing the at fault insurance company or they do not do what is called third party billing.
They want to bill you, the individual. Many people are under the impression that doctors across the united states will bill the at fault party’s insurance company after a car wreck, after all, the accident was not there fault. Pip states are considered no fault states.
Table of contents
- What is Third Party Billing In the Healthcare industry
- Third party Billing the insurance company in Car Accidents
- Finding a doctor who will bill the at fault auto insurance company
What is Third Party Billing In the Healthcare industry
Third-party billing refers to the process of submitting and processing medical claims for reimbursement from a third-party payer, such as an insurance company. It is a fundamental aspect of the healthcare billing and reimbursement system.
Here’s how the process typically works in General Healthcare:
A patient receives medical services, such as a doctor’s visit, hospitalization, laboratory tests, or prescription medications, from a healthcare provider (e.g., hospital, clinic, physician).
The healthcare provider compiles all the relevant information about the services provided, including the diagnosis, procedures performed, and associated costs. This information is organized into a medical claim, which is then submitted to the patient’s insurance company or another third-party payer.
Verification and Adjudication
The third-party payer reviews the submitted claim and verifies its accuracy and completeness. This may involve confirming the patient’s eligibility, coverage details, and compliance with any pre-authorization or medical necessity requirements. The claim is then processed and adjudicated, determining the amount of reimbursement the healthcare provider will receive.
Payment and Reimbursement
Once the claim is approved, the third-party payer reimburses the healthcare provider for the covered services based on the agreed-upon fee schedule or negotiated rates. The payment is typically made directly to the healthcare provider, although the patient may be responsible for any co-payments, deductibles, or non-covered expenses outlined in their insurance plan.
After the claim is processed, the patient receives an explanation of benefits (EOB) statement from their insurance company. The EOB details the services rendered, the amount paid by the insurance company, and any remaining patient responsibility, such as co-insurance or deductibles. The patient is then responsible for paying their portion of the bill directly to the healthcare provider.
By utilizing third-party billing, healthcare providers can streamline their administrative processes and focus on delivering care while relying on the expertise and resources of insurance companies or other third-party payers for claims processing and reimbursement. It also provides patients with the convenience of having their medical expenses handled through their insurance coverage, facilitating access to healthcare services.
Third party Billing the insurance company in Car Accidents
Third-party billing refers to the process of submitting medical claims for reimbursement from a third-party payer, such as an auto insurance company. Most doctors do not get reimbursed from the at fault party’s insurance company. In states that utilize pip or medpay, this may be how it works.
Personal Injury Protection
In the context of Personal Injury Protection (PIP), third-party billing refers to the process of submitting medical claims and seeking reimbursement from the responsible party’s PIP insurance coverage.
PIP is a type of insurance coverage that provides benefits for medical expenses, lost wages, and other related costs resulting from an automobile accident, regardless of who was at fault. When an individual is injured in a car accident, they can seek medical treatment for their injuries and then submit the medical bills to their own PIP insurance provider for reimbursement.
However, in some cases, if another party is found to be at fault for the accident, the injured person may have the option to pursue reimbursement from the at-fault party’s PIP insurance coverage instead of their own. This is where third-party billing comes into play.
General overview of how third-party billing works in PIP and Med pay:
The injured person receives necessary medical treatment for their injuries resulting from the car accident. This can include visits to healthcare providers, diagnostic tests, surgeries, medications, rehabilitation, and other related services.
The healthcare providers who treated the injured person compile the medical bills and necessary documentation, including medical records, treatment plans, and invoices. These documents are then submitted to the at-fault party’s PIP insurance provider.
The PIP insurance company of the at-fault party reviews the submitted medical claims to ensure their validity and assess whether the treatments and expenses are reasonable and necessary. They may also verify the relationship between the injuries and the accident. The claim is then processed and adjudicated for reimbursement.
If the third-party PIP claim is approved, the at-fault party’s insurance company reimburses the healthcare providers for the covered medical expenses, based on the applicable fee schedule or negotiated rates. The payment is typically made directly to the healthcare providers.
It’s important to note that the specific process and requirements for third-party billing in PIP may vary depending on the jurisdiction and insurance policies involved. It’s advisable for individuals involved in car accidents and seeking reimbursement through third-party billing to consult with their insurance company, legal counsel, or a qualified professional to understand the specific procedures and requirements applicable in their situation.
What that means is if you are injured in an auto accident, your insurance company pays for your medical up to the dollar specified amount. If you have Med Pay or medical payments, the doctor will bill the med pay, which is usually on your insurance or the person you were riding with.
Doctors who bill the at fault auto insurance company is common in states around the US that don’t have Pip. Finding a doctor who will do this, is no easy task. Most Medical doctors, Orthopedics, Neurologist are not set up to do third party billing. A doctor who will bill the at fault party’s insurance company is someone who we list on our website.
Doctors who bill the at fault party insurance company are set up for this type of billing. Although it is rare for a physician to actually bill the insurance for there services, it does happen in non pip states. If you do not have an attorney, the doctor will bill the at fault party’s insurance company. Many doctors do not like doing this because there is no guarantee that they will ever be paid for there services.
Having no personal injury lawyer involved in your case may make a doctor not want to take the chance of not getting paid. When they have an attorney involved they can file a medical lien with the attorney. A medical lien will protect the doctor so that he will receive payment for his services rendered when the case is settled. Some doctors encourage patients not to seek an attorney and they will bill the at fault party’s insurance company. It might be best to speak with a personal injury attorney before taking this route.
When you have a lawyer, the doctor more than likely will just file a lien with the attorney. However, in some cases where you have pip or med pay, they will just bill your auto insurance. Most Doctors in the United States work in this manner. The lawyer will sign a lien, the doctor will treat your injuries.
And when it’s all over, the at fault party’s insurance company pays for everything. Some doctors will require you to have a lawyer before they will treat you, its there insurance.
At Fault Insurance companies doctors will bill
American Chiropractic Network
Blue Cross Blue Shield
Care Improvement Plus
Commerce and Industry
GA Farm Bureau
How people think the at fault billing works & how it really works
Doctors who bill the at fault auto insurance company are quite rare in most states. Virginia, is one of the very few states were doctors will do this. The laws favor the doctor, and the auto insurance company is obliged to do this. Third party billing is when you have pip or med pay. In turn, the doctor bills your insurance company. Most doctors work on attorney liens across the nation in non pip states.
We all want the at fault auto insurance company to be responsible for everything, and they will be. However, in order to get to the end, we have to start treating. And to do so, requires an attorney’s lien. The attorney will then make the auto insurance company pay for your medical and pain and suffering. This does take time, in the meantime you can treat under a attorneys lien.
Finding a doctor who will bill the at fault auto insurance company
When you need to find a doctor who will treat you after a car wreck, you have come to the right place. We help thousands of people every year find a one in there area that will bill the at fault party insurance company or on a medical lien. Forms of payment should not be a factor in your receiving proper treatment after a car wreck.
We know how hard it is to find one who will bill the at fault insurance company, we are here to help you find one. You can find a doctor in your area by entering your zip code in the upper right hand corner of every page on this website. If we do not have a doctor listed in your area that will bill the at fault insurance company. Please contact us immediately, we will and help you find one.