3rd Party liability vs. private health ins

[Maerin]

What is the name of your state? Missouri

I work for a healthcare provider. A patient comes in and uses their private health insurance. We bill that insurance and are paid. If the injury that we treated them for is found by the court to be the result of a auto accident do we have the obligation to refund the health insurance and obtain payment from the settlement. This would be a better deal financially for us because when we receive payment from health insurance we take large discounts on the balance. Also court settlements are often based on the total amount our treatment cost. Let me know about any Missouri law that pertains to this.

 

[stephenk]

When a patient comes in for treatment, do you determine at the first visit whether the injury is from an accident where a third party claim is being made?

In California, when a medical provider accepts insurance payment for patient care and the amount is discounted, the discounted amount is determined to be the value of the treatment not what the medical provider billed. This is conditioned on the medical provider accepting the discounted amount as a full and final payment. Depending on what carriers you are connected with, you may not have the option to accept insurance payment and still try and get more money from the patient.

You can also put a lien on the case with the patient's attorney and not bill the insurance carrier. you would then have to wait for the case to resolve before receiving any payment. Again, the patient's attorney may want you to accept a discount for the services.

 

[Maerin]

Missouri

If a patient says his injury would be a result of an injury that someone else is responsible can we even pursue the third party for payment? Wouldn't the court have to determine who was responsible, and in the meantime wouldn't we be required to bill the patient's health insurance?

Does anyone have any info on Missouri law for this?

 

[stephenk]

you dont pursue the third party for payment. You can submit your billing to your patient's insurance carrier with the provision that you will not accept the insurance company's reduction of the bill as the final amount but you will expect the patient to pay the balance. You can then have your patient sign a lien whereby your clinic gets paid the balance after the case settles.

 

[ProResearch]

Generally, in Missouri, it is the health insurance that goes after the 'third-party' claim, not the health care provider *if* the patient uses his health insurance in treating injuries for which another party is responsible for.... The health provider has a contract with the insurance company to provide services at a certain price. Most of the doctors and facilities I treated with advised me to use my health insurance after the car wreck I was in (when the #&@$* ran the red light and slammed into me), saying that it would be more expensive not to use it. It is the general consensus, and indeed, written in many health insurance policies, that the health insurance will subrogate against any settlement money paid to the patient and get their money back.

If what Maerin is saying happens, then health care providers may wait [potentially] for years for payment of their services, and we know that does not go well for the patient or her/his credit. It is best if the health insurance does its job for which the patient pays premiums for. Then let the health insurance get its money back from any settlement.

Of note is this link: http://www.senate.state.mo.us/96info/bills/SB743.htm

You can do a search on that site for more info related more particularly to your scenario.

I would like to add that I have one health care provider who *after* treating me and after receiving payment from my health insurance says 'wow, we should give the money back to the health insurance company and get payment from you after you receive your settlement.' I then informed the health care provider that my health insurance has already contacted me and that I will pay them back from any settlement proceeds -- so not to worry.

I don't think the health care *providers* should really be in this mess, frankly. It's way complicated already!!! They get paid for the services they render and if they choose to contract with a health insurance company and receive a "contractual" price rather than "full" price, and the patient uses their health insurance with the health insurance's knowledge, what can the health care provider say?

Just my 2 centavos....