After twenty years of practice, I regularly encounter the following ten questions:
1. Should I bill the patient*s health insurance?
Yes! Your patient*s health insurance is obligated to pay medical bills incurred regardless of cause. The fact that your patient was in an automobile collision does not limit the obligation of the health insurance provider to pay for medical bills that have been incurred. Insisting that your patient pay with automobile insurance rather than health insurance puts a health care provider*s interests at odds a patient*s interests. At Foust Law Office, we will insist that the health care provider bill our client*s health insurance before any proceeds are paid by the patient. Refusing to accept the patient*s health insurance is in violation of the agreement the health care provider has with the health insurance carrier. Abiding by the contract you have with the health insurance carrier is a legal obligation that cannot be ignored. It is good business to bill the health insurance provider and it is the right thing to do for your patient.
2. What is medical pay insurance?
When your patient purchased automobile insurance coverage, he or she was provided the opportunity to purchase medical pay insurance coverage (med pay). Med pay covers medical bills incurred as the result of an automobile collision regardless of who is at fault. If a motorist is drunk, crashes into a utility pole, and is treated at the hospital, med pay will pay the medical bills up to the policy limit. I recommend that people purchase as much medical pay coverage as possible. Med pay should be used in addition to health insurance. Med pay coverage is often limited to $1,000, $5,000, or $10,000. These amounts often coincide with the costs of health insurance deductibles.
Medical pay is particularly helpful for payment of bills that are not covered by health insurance, or the amount of treatment is limited by health insurance. Frequently, the number of physical therapy treatments or chiropractic treatments available to your patient is limited by the health insurance carrier. As explained in question number one above, health insurance must be the primary source for payment and medical pay should be considered a supplement to that payment.
3. Can the automobile insurance company pay less than the amount billed?
No. So long as the billing is reasonable and within the amount billed in your specialty in your area, the automobile insurance carrier is obligated to pay the entire amount of your bill. If you are having problems with an insurance carrier discounting your bill, please call us!
4. Is the patient double-dipping by receiving medical pay and payment from the other driver*s insura
No, absolutely not!!! As explained in question number two above, medical pay insurance is a no fault insurance policy purchased by your patient. The contract requiring the automobile insurance company to pay is completely separate from the legal obligation of the other driver*s obligation to pay for damages he or she has done to your patient. The medical pay insurance purchased by your patient is similar to buying a chip at a roulette wheel or other game of chance. Insurance is no better or worse than legalized gambling. Finally, your patient should understand that making a claim under the medical pay portion of his or her insurance policy WILL NOT increase his or her premiums. After all, a roulette dealer will gladly accept your next bet for the same rate, even if you *won* the last time you played.
5. What can we charge law offices for photo copies of our file?
Believe it or not, there is a law covering this very question. Under Section 50-16-540, MCA, *a reasonable fee for providing health care information may not exceed 50 cents for each page for a paper copy or photocopy. A reasonable fee may include an administrative fee that may not exceed $15 for searching and handling recorded health care information.* Please cite to this statute if another law firms or insurance carrier gives you a hard time about your billing.
6. What happens if our patient has his or her bills paid by Medicare or Medicaid?
If your patient receives Medicare or Medicaid benefits, your patient has a right to bill Medicare or Medicaid for payment of his or her treatment. Medicare and Medicaid have a right to be reimbursed from the proceeds of the settlement or funds received in an automobile claim. If you accept Medicare or Medicaid, you may not ask for additional funds comprising the difference between the amount billed and the amount paid by Medicare or Medicaid. The patient will be obligated to reimburse Medicare or Medicaid, usually at a schedule that contemplates the amount of the settlement and the amount of the attorney fees.
7. Can the automobile insurance company simply stop making payments without a reason?
No! However, this will not stop an insurance carrier from attempting to drum up a reason and discontinue payment. This is particularly true when a claimant is not represented and attempting to navigate an insurance claim without an attorney. Although most people do not need an attorney to resolve their insurance claim, cutting off needed medical treatment is a good impetus to retain counsel.
8. What rights does my office have after submitting a medical lien?
As a health care provider, you have a right to submit a lien to ensure your receipt of payment. Your lien may be presented to a law office to protect your right to payment a beneficiary is eligible to receive under an insurance policy. A law office must recognize your lien and make payment accordingly. However, the attorney*s lien takes precedence under Section 37-61-420, MCA. In instances where there is not enough insurance coverage to pay all of the medical bills, a law firm may attempt to negotiate the amount of your lien or attempt to reduce the amount you are to be paid. Once the circumstances are explained, we have found health care providers to be very reasonable in the amount you accept. Please remember, the attorney is obligated to protect the interest of his or her clients when negotiating a discounted amount for the lien.
A medical lien must be updated with an appropriate amount due or it will not be recognized. Regularly updating your medical lien with current charges and current information will allow a law office or insurance carrier pay those balances.
9. What if the medical bills are more than the settlement?
In the event of catastrophic injuries and significant medical bills, your patient may be driven into bankruptcy. If this is the case, you may be limited to whatever funds the bankruptcy trustee has available. This is typically a pro-rata share of the funds that are available. This process can take months.
How does our billing change after a case is settled?
If additional medical treatment is required after a case has settled, it is likely that the patient is the one who is responsible for payment. Attorneys are obligated to address any and all liens they have received prior to disbursement of funds. As such, your office must stay on top of its billing and notify the law office of outstanding medical bills prior to settlement. At our office, we make it a point to communicate with each and every health care provider prior to settlement. This prevents any surprises for our clients, your patients.
Our Rating is calculated using information the lawyer has included on
their profile in addition to the information we collect from state
bar associations and other organizations that license legal
professionals. Attorneys who claim their profiles and provide Avvo
with more information tend to have a higher rating than those who do
What determines Avvo Rating?
Experience & background
Years licensed, work experience, education
Legal community recognition
Peer endorsements, associations, awards
Legal thought leadership
Publications, speaking engagements
This lawyer was disciplined by a state licensing authority in .
Disciplinary information may not be comprehensive, or updated. We recommend that you always check a lawyer's disciplinary status with their respective state bar association before hiring them.