Which insurer should get your crash medical bills
Notes from a patient benefits coordinator
After a crash, you may get separate bills from the hospital, the ambulance service, an imaging center and a specialist. A bill showing up at your home doesn’t tell you which insurer should pay first. Give every provider the crash date and details for any coverage that might apply. Then ask the insurers and the billing office how to route the claim. [1, 2]
Gather your claim details
Write down the name of the insurer handling your auto injury benefits. Add the claim number, the adjuster and the mailing or electronic billing address. Include your health plan details. Let the provider know whether the care is tied to the crash. A rejected bill may need to go out again. Before it does, ask the provider to confirm the patient name, service date and claim number all match. [1, 2]
Find out who pays first
PIP or medical payments coverage may pay first for some care. Your health plan may pay once an auto benefit runs out, or it may follow its own rules. Medicare has its own rules for coordinating payment and possibly getting paid back. Don’t pick a payment order based on a general article. Ask each insurer what it needs, and get its answer in writing when you can. [1, 2, 3]
Track each bill to the end
For each provider, note the amount billed, which insurer got it, what was decided and any balance sent to you. Check bills against the explanations of benefits. If a bill went to the wrong place, ask the provider to fix it and send it again. Keep track of filing deadlines so a routing mistake doesn’t turn into a late claim. [1, 2]
What to ask the billing office
- Which payer did you bill first?
- Which claim number and date did you use?
- What’s left after insurance processed it?
Make a payer list
Put your payers on a single page and give a copy to each provider treating you. [1]
Sources and further reading
- 1New York Department of Financial Services, no fault provider billing
- 2Texas Department of Insurance, auto medical benefits
- 3Centers for Medicare and Medicaid Services, coordination of benefits
General education written from a patient benefits coordination view. Who pays first depends on state law, plan terms, the injury and the auto coverage available. Medicare follows its own coordination rules.
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