Pennsylvania’s automobile insurance laws present unique challenges to hospitals seeking payment. Because the law makes auto insurance medical payment coverage (i.e first party benefits) primary over health insurance for care related to an automobile accident, providers find their payments, including payments from secondary health insurers, delayed for several reasons. Hospitals find themselves at an impasse with automobile insurers, health insurers and patients.
In Motor Vehicle claims, the most common missed revenue opportunities are:
Patients fail to comply with requests for information from the auto insurer regarding other possible coverage or won’t verify that they have no auto insurance. As a result auto insurers delay payment while they “investigate” claims or they deny payment based on a coverage dispute. Each of these scenarios adversely affect hospital cash flow by delaying payment of first party benefits which, in turn, delays payments by health insurers.
There are many reasons why patients are reluctant taking the necessary steps to seek payment from their motor vehicle insurer. Some fear a claim will raise their premiums. Others believe that the other party should be responsible for their medical bills and some think it better to have their health insurance make payment. They will ignore letter after letter and call after call from hospitals or their outsource vendor. This reluctance, however, often fades when they are contacted by an attorney and told that if the claim is not paid, they will have to pay it themselves. Many patients are under the misconception that hospitals are not permitted to seek payment directly from them if they have health insurance. Our office will work with the patient and gain their cooperation and, only as a last resort, will file suit asking a court to compel their cooperation in complying with the requirements of their health insurer or automobile insurer.
In addition to working with the patient to understand their legal obligation to work with the healthcare provider, our office works with hospitals to develop forms that can be used during the registration process enabling the hospital to submit claims directly to automobile insurers. By developing standard patient registration tools, healthcare providers strengthen their legal position if relief is sought in court. Commonly developed tools include assignment of benefits forms, standard insurance claims forms, and other like documents.
SLOW PAY INSURER
As with workers’ compensation, the cost of care provided at a trauma center or burn unit for auto accident related injuries is not subject to the auto fee schedule. Improper application of the fee schedule can affect the payments made by secondary insurers, reducing them greatly.
Healthcare Insurers’ and patients’ attorneys will try to reduce the outstanding balance by applying the fee schedule, depriving the hospital of full payment. Our attorneys are experienced in dealing with these issues and with the insurers’ counsel. We understand the law and will hold the patients and their attorneys responsible for complying with the law through court intervention, if necessary.
When a patient has no health insurance, our office will make an assessment to determine if third party action exists and will prepare necessary legal documents to ensure that the hospital’s rights to payment for the care is protected in any settlement or litigation.. Letters of protection are usually offered by the patient’s attorney but are generally drafted to protect the patient, not the hospital. As a result they often prove to be useless in securing payment. Our attorneys have represented individuals in personal injury claims and understand how to secure promises of payment that are binding. We will not hesitate to seek relief in court to protect the hospital’s right to payment.
Many of the same problems arise when a patient is injured and is seeking recovery for their injuries from another party. If they lack health insurance or their coverage excludes payment for care related to injuries caused by others, the only source for payment of the hospital bills may be the settlement they secure from the other party. Through the use of appropriately worded Assignment of Benefit forms and aggressive follow up with the patient and their attorney, Audley Law Offices, P.C. can assist you to secure portions of these settlements to pay outstanding medical bills.