How do healthcare providers know what insurance to bill?

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There are often multiple insurance policies that might apply after someone gets hurt. Obviously, healthcare providers at physician’s offices and hospitals are in the habit of billing health insurance policies. However, an individual’s health insurance provider may not actually be the party that is tasked with financial responsibility after a patient gets hurt.

There are frequently other insurance policies that come into play instead of someone’s health insurance. Healthcare providers need to be very cautious about how they handle billing in a scenario involving accidental injuries. Car crashes, dog bite incidents and injuries that occur while someone is at work are all examples of scenarios in which a different insurance policy other than basic health coverage might apply.

How does a healthcare provider know who to bill?

Coverage often comes down to liability

Determining who should pay for someone’s care costs and lost wages often requires a review of the circumstances that led to the person getting injured. Insurance companies sometimes handle the process between themselves through subrogation. A health insurance provider that paid for someone’s treatment would make a claim against a different insurance policy when it is clear there is outside liability for someone’s injuries.

In a scenario involving a work injury, for example, it will typically be an employer’s workers’ compensation coverage that will pay for someone’s healthcare costs. Billing the right insurance can be very important for the patient, as their health insurance may pass costs to them while workers’ compensation coverage would not.

If a dog attacks and bites someone, it will often be the homeowner’s insurance of the animal’s owner that will cover someone’s costs for medical treatment, although attacks that occur at a business may involve a premises liability policy instead. Motor vehicle crashes may lead to claims against workers’ compensation coverage if they occur while someone is on the clock or against the bodily injury coverage provided through motor vehicle insurance.

Healthcare providers typically need to ask questions about the circumstances that led to someone’s injury to determine what insurance policy might apply.

Improper billing could lead to criminal charges

Insurance companies, especially government insurance programs, often take a dim view of medical practices that make significant billing mistakes. From billing to companies for the same treatment to changing the billing code to seek more compensation, there are numerous small mistakes that healthcare providers and their insurance billing specialists might make that could lead to criminal charges in some cases.

Learning more about appropriate insurance practices with the assistance of a legal professional can help healthcare providers and their support staff minimize their risk of financial criminal charges.