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AUTOMOBILE AND WORKERS COMP INSURANCE
 



Automobile Medical Insurance                                                 

Automobile insurance coverage for medical services can be a tricky to understand and to get paid.  First, you must know if your state is "No Fault" or not.   This will be one of the hardest things for you to explain to your patients.  In a "NO Fault" state the automobile insurance to bill is the patient's automobile insurance first whether they were at fault in the accident or not and whether or not the were the driver or the passenger.  For instance, Florida is a "No Fault" automobile state and any kind of accident that involves an automobile whether the vehicle was running or not is considered an automobile accident.  You will need to get their automobile insurance and then their medical insurance as a back up.  The accident will need to be reported by the patient, a claim number gotten as well as a billing address for claims.  After the initial emergency treatment given to the patient any follow-up medical care must be approved by the claims adjuster and done at the approved medical facility.  Quite a few automobile accidents end up in litigation and thus you will need to deal with lawyers.  This will delay processing of your claims.  If they are delayed too long you can get sometimes get payment from the medical insurance company pending settlement of claims.  You will need to go to your State Insurance Commissioners website to see what rules pertain to your patients.
 
Workers Compensation Insurance

Almost every single employer must have some kind of workers compensation coverage that covers their employees when they get hurt while doing their job.  Each state has a Workers Compensation Division website to give you information on coverage issues, billing issues and payment amounts.  Basically, when a employee is hurt on the job and must seek medical treatment the initial treatment can be done at a local emergency room or preferably at the approved urgent care facility, if they are open at the time.  The employer must file a report to their carrier with the pertinent information about the accident, the employee and the nature of the injury.  The insurance will assign a claims adjuster and a claim number.  Any further medical treatment must be prior approved by the claims adjuster.  No other insurance can be billed unless their insurance carrier denies payment, the claim goes into litigation or the insurance company fails to pay or deny within the time frame allowed by each state.  As a provider you required to accept payment from the workers compensation carrier based on the state's fee schedule as payment in full.

There are two considerations you might need to research further.  One is if your patient is hurt in an automobile accident and was on the job at the time who would be primary in that case.  These are generally determine by each state.  The second consideration is what special circumstances may be surrounding a given profession.  For instance, in our area our police officers who are having a heart attack while at work is considered a workers comp claim.