Wednesday, November 18, 2009

What If Your Doctor Or Chiropractor Won't Bill Your Health Insurance Company After An Accident?

If you've been injured in a collision or for any other reason (a slip and fall in a store, for example), your medical provider may just tell you: "there's no need to bill your health insurance company." This provider may insist on having you sign a paper stating that you must pay their bills out of your settlement if you settle your case in the future.

If you live in Ohio and have health insurance, this practice may be illegal. Ohio law says that:

every provider or health care facility that contracts with a health insuring corporation to provide health care services to the health insuring corporation's enrollees or subscribers shall seek compensation for covered services solely from the health insuring corporation and not, under any circumstances, from the enrollees or subscribers, except for approved copayments and deductibles.

What this means is that, if you have health insurance, your medical provider must bill your health insurance company if that provider is a member of your health insurance network or plan. The reasoning is simple: if medical providers agree to be listed as members of a health insurance plan, they must abide by the rules of the health plan. In exchange for being sent or accepting patients, providers agree to be paid what is "reasonable and customary" for their billed services.

So why would a medical provider seek to skirt the agreement and Ohio law on this issue? Example: if your bill for your accident related injuries is $2000, the "reasonable and customary" payment might be $1,300. By trying to get you to bypass submitting the bill to your health insurance company, the provider is attempting to be paid dollar for dollar for his or her bill--$2,000 in the example above.

If you come across this practice, you need to report it to your health insurance company immediately. Many times I have had to write a polite letter to providers reminding them of their obligation under Ohio law to bill health insurance.

And here's why it's beneficial in almost all instances to submit your accident or collision related bills to your health insurance company.

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