Forum - Questions & Answers

Jun 10th, 2014 - Sha12 62 

Auto vs office visit

Pt came in for sinus inf & hand pain. We billed his medical ins & got denied stating it is auto liable. We did not know that the hand pain was Auto related accident. I called ins & told me to bill Auto. I did not agree w/ the idea of sending this claim to Auto because the primary diagnosis was for sinus inf. Any suggestion on what should I do. I would greatly appreciate it. Thanks!

Jun 10th, 2014 - LBAROGIANIS 250 


I will bill auto first, maybe they will pay in full. If they denied, then you can bill health.

if the accident happened recently you might be able to get paid by auto in full.. If the benefits are exhausted, then you'll receive an exhaust letter to bill health...

Jun 10th, 2014 - Sha12 62 


@Townsend: That was my concern, the primary reason for the visit was sinus inf, not for hand pain. It just happen he mentioned it to the doc. The medical ins even told me if it get denied, they may or may not pay for it.

Jun 10th, 2014 - Townsend 5 


If the patient came in for the sinus infection and happened to mention the hand pain, I would appeal to the medical insurance as a sinus infection would not be accident related (unless it was a consequence of some kind of facial injury). However if the patient came in with the chief compliant of hand pain and happened to mention the sinus infection then I would bill the auto insurance.

The claim should be directed according to the primary diagnosis that the provider was seeing the patient for and treating that day; not whichever one gets paid the easiest.

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