This is my first customer related rant in current job. I’m an insurance biller for a hospital. I make sure the claims are filed properly and paid according to the patient’s policy and/or our contract with the insurance companies.
It is standard procedure in cases of auto accident related claims to file the claim with the at-fault driver’s auto insurance company before filing with the patient’s regular health insurance. Even if there is no med pay available, we have to show proof we attempted to file the claim.
A $6,000 claim came up on my report this past week. In the notes on the account, it was indicated that the parent of the patient (a minor who was at fault) did not want to file with the auto insurance company because it would make the premiums to go up. I can certainly understand this.
One problem: the main insurance is notorious for not paying claims of this nature unless the auto insurance has been billed first. They are well within their rights to do so and it is usually written into the patient’s policy.
When something like this comes up, I send a letter to the insured requesting the information I need and then file the claim for the patient.
Today, right before I’m about to leave, I get into this conversation:
Insured: I got this letter requesting information. I’ve already said I didn’t want to file with my auto insurance because it’ll cause my insurance to go up. I wanted you to file with my health insurance.
MBS: Well, you really don’t have a choice. If I try to file this with the ins co, they’ll see that it was accident related and request the info from you themselves. They won’t pay until they get it.
INS: You don’t have to tell them it was an accident.
MBS: They’ll see the diagnosis codes and figure it out.
INS: Can’t you change the codes?
MBS: No. That would be illegal. (true!)
INS: But, I don’t want to file with my auto insurance.
MBS: Then you’ll have to pay the entire bill.
INS: (moment of silence) Can I get a copy of the itemized bill?
MBS: Sure. Let me verify your address. (which I do). I’ll get a copy in the mail.
INS: Thank you.
My guess is that she’s going to try an end run around us and file the claim directly with the insurance company by altering the bill somehow. This won’t do her any good. The insurance company will contact us for a claim form and when they see that it doesn’t match, they’ll ask for an itemized bill for themselves. If she doesn’t, we will continue to bill for the full amount of the claim.
The insurance company has one helluva contract with us and we’ll be lucky to get 15% of total charges from them and another 2-4% from the insured.
At this point, I could get a copy of the police report in order to get the insurance info, but I have to give the insured a chance to volunteer the information.
I can’t imagine the auto insurance going to go up more than $6K. If it were me, I’d either make the minor pay the difference in the premiums or boot them off the policy and make them get their own insurance.
This idiot might be facing insurance fraud charges because they think they’ll be saving money.
Due to HIPAA regulations, I have rendered the facts in a vague manner.