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Practice Management Alert

Reader Questions:

Ask MVA Carrier What Services It Will Cover

Published on Sun Sep 19, 2004

Question: A patient of ours was involved in a car accident and admitted to the hospital via the emergency department. The accident appears to be related to the patient's health status: He was involved in other accidents in the past because he had syncopal episodes or blacked out. After this latest accident our physician diagnosed the patient with severe coronary artery disease and recommended coronary bypass surgery. Should we bill the patient's motor vehicle insurance for the surgery because of the car accident? Or can we bill his regular medical insurance for this service?

- New Hampshire Subscriber Answer: The patient's regular medical insurance is probably responsible for coverage of the coronary bypass surgery because the patient's coronary health - not the car accident - is causing the need for surgery. You could bill the MVA carrier for the emergency department service and for treatment of any injuries the patient suffered in the car accident.
 
Of course, every auto coverage plan is different, so your best bet is to get in touch with the MVA carrier to see exactly what services it will cover. You should bill the patient's regular medical insurance for all services the MVA carrier won't cover.
 
Note: Before calling the MVA carrier, try to obtain more specific information from your physician so you know whether the patient's heart condition truly caused the accident. The more information you can provide to the MVA carrier, the easier it will be to sort out the billing situation.
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