I am often surprised that a certain percent of you do not know what “Medical Payments” coverage is. Quite simply, medical payments coverage (more commonly referred to as “Med Pay”) is a separate coverage available on all Tennessee insurance policies that acts as a “no-fault” type of coverage.
You have access to this coverage regardless of whether your patient is at fault.
Why Should you Care about Med Pay?
What most PCP’s and orthopedic doctors do not know (and what chiropractors figured out long ago) is that you can get reimbursed for your office charges at 100% of the reasonable value of the charges. That’s right, med pay is responsible for paying your charges 100% up to the limits of your patient’s coverage. There is no sliding scale or comparable Medicare reimbursement rates. If your office visit is $350, and that is a reasonable charge, then you are entitled to receive full compensation. Also, the turn around time of payment in med pay claims is usually less than 30 days. You submit it, then you get a check.
How much coverage is available?
The amount of coverage is selected by the patient at the time they apply for the auto policy. Common limits are $1000, $2,000, or $5,000. I have seen med pay limits as high as $25,000.
How Do I Access this Coverage to get paid?
Great question. All you have to do is get a copy of your patients auto insurance card, identify the auto insurance carrier, and simply call them up with your patient right there. Usually, there is a separate “med pay” adjuster who is assigned with the specific tasks of paying the medical payments claim directly. Some carriers require a HCFA form, while most do not. The med pay adjuster will also want to see accompanying notes in order to causally link the cause of the treatment to the wreck at issue, and not to some other, non-auto related cause.
If your patient has the normal aging degenerative changes which you feel necessary to note in your records, you need to specifically address any exacerbation of an underlying condition specifically. You have to remember the insurance adjuster is looking carefully to see if there is any cause of the treatment that is unrelated to the wreck at issue in order to avoid any responsibility for payment. If it is not a significant factor, it is best to leave out degenerative changes altogether in order to lessen the chance the insurance adjuster will get an out. Sometimes the adjuster will deny it, regardless of how well you document your findings.
If my client has an Attorney, does the attorney get to keep a portion of the med pay?
No. In our practice, we never take a portion of the med pay money. My office facilitates this med pay processing for many doctors offices and we give you guys 100% of YOUR MONEY. Not 80% or 90%…but 100% to you. I have had several doctors state that when their patients are asking them for attorney referrals, the doctors try to max out, or “exhaust” the med pay so that the attorney will not keep their money. That is stinkin’ thinkin’ on several levels. First, it is not true. Secondly, your client may be making several mistakes in the interim that is damaging the long-term value of their case, all while you are worried about the attorney taking your med pay money. Thirdly, our office can likely get the money to you more quickly than if you handle this yourself. We have already established contact with the liability adjuster and the med pay adjuster once we have become involved in the case. We facilitate this process as part of our service to our client (for free!).
If you have an attorney that has kept part of your fees, you need to call me to discuss your options in that regard. That should not be happening.
If your office or your patients have any question about these matters when dealing with the auto insurance industry, please call John at GriffithLaw, at 615.807.7900 or contact me via our website.