Can I bill my patient after they’ve been denied?
When a medical provider treats a patient and bills their No-Fault insurance they execute either an Assignment of Benefits or Authorization to Pay with the patient. The use of either an assignment or authorization is a critical difference for medical providers. If an Assignment of Benefits is signed by the patient and the insurance company denies payment of their patient’s medical bills the medical provider cannot thereafter bill the patient for the unpaid bill. This includes sending the bill directly to the patient, billing the patient’s “back-up” secondary insurance or sending the bill to collections – doing so violates the New York Insurance Law. The medical provider’s only option is to fight the denial against the insurance company through either arbitration or litigation.
The New York State Insurance Department issued the following statement summarizing some of the important differences between an Assignment of Benefits and an Authorization to Pay Benefits:
The effect of acceptance of an assignment of benefits by a health provider is that by accepting the transfer of the right to receive benefits, which were available directly to the eligible injured party, the health provider also assumes the right to, and responsibility for, pursuing available remedies when claims are denied, since the assignee provider now stands in the shoes of the eligible injured person. Therefore, after an assignment has been effected, an assignee provider, who has submitted a claim for services rendered, must be the party to request and pursue arbitration when the claim has been denied.
Are an injured worker’s medical expenses paid for by No-Fault or Workers’ Compensation?
When a person is injured through the use of a vehicle while in the course of employment, New York’s No-Fault Law states that the sole source of benefits for medical expenses shall be the Workers’ Compensation carrier 11 N.Y.C.R.R. 65-3.16 (9) states “Pursuant to section 5102(b)(2) of the Insurance Law, when the applicant is entitled to workers’ compensation benefits due to the same accident, the workers’ compensation carrier shall be the sole source of reimbursement for medical expenses.”
Does No-Fault pay for medical treatment for the aggravation of a previous injury?
Yes. 11 N.Y.C.R.R. 65-3.14(a) states “An insurer shall be liable only for the payment of benefits for losses caused by the accident, including those caused by the aggravation of preexisting conditions.”
Can a patient still apply for No-Fault benefits more than 30-days after the accident?
Although the NF-2 form is preferred by insurance companies when applying for No-Fault benefits there are other means provided for by law to satisfy the 30-day notice requirement of 11 N.Y.C.R.R. 65-3.3. For instance, the insurance company’s receipt of “a Department of Motor Vehicles Accident Report 104 (MV 104), or other accident report indicating injuries to eligible injured persons, shall be deemed written notice of a claim.”
How can I fight a denial?
Coming soon...“Fighting a Denial” to find out how to get your medical bills paid.
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