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Requesting Med Pay Reimbursement

How to Request MedPay Reimbursement

Once you’ve opened a Medical Payments claim with your own auto insurance company, the next step is to submit your medical bills and records for reimbursement. However, this process is not as simple as faxing a copy of the patient bill you just received in the mail over to your adjuster. There are three main components to requesting your MedPay Reimbursement:

  1. Collecting the proper medical bills and records
  2. Submitting them to the adjuster
  3. Collecting/reviewing reimbursement and correspondence

If you’ve ever had to request your medical bills and records in the past, especially from a large medical provider, such as a hospital, you know how challenging and time-consuming this can be. MedPay adjusters will only reimburse “reasonable” and “medically necessary” medical expenses up to the specified limit in your auto insurance policy. This means adjusters are going to be looking for very specific information that shows that the treatment you received was necessary in accordance with injuries sustained in an accident.

When you open a Medical Payments claim, your adjuster will send you a packet in which they list exactly what type of information they need in order to process MedPay reimbursement. While the information required will depend upon your insurance company, there are certain items you should always make sure are included. The best way to ensure you have the necessary information is to ensure you are requesting the right information directly from the medical provider.

What to Request

  1. Itemized medical bills from each provider that include diagnostic and procedure codes (also known as CPT and ICD-9 codes)
  2. The medical records that correlate with each medical bill

How to Request Your Bills & Records

The best way to request bills and records is to call each provider and ask them how they prefer that you request copies of these medical bills and records. You may be asked to come into the office or send a written request by email, fax, or mail. You may also be required to sign a release or provide identification to confirm you are the one authorized to collect this HIPAA-protected information. In some cases, you may even be required to pay for copies of these bills and records. North Carolina law mandates that a medical provider can charge a “reasonable fee” to cover the costs of producing the records, but the maximum fee is 75 cents per page for the first 25 pages, 50 cents per page until 100 pages, and 25 cents per page after 100 pages. Further, if you have a lien at that healthcare facility, North Carolina law prohibits that they charge you for any bills or records. If you do have a lien and they charge you for your records, the lien will no longer be perfected and may not be enforceable. For more information on perfected liens and how they may affect your settlement, click here.

It is also important to keep in mind that some medical providers have a separate billing department from their records department, so be sure to ask the customer service representative on the line if one request can be sent for both bills and records, or if you will have to make the requests to separate departments. The patient bills you receive will often just reflect the remaining balance. This is of no use to the adjuster, and if you send those bills, they will send them right back to you with a request for additional information.

Mistakes to Avoid

If you do not provide the correct information, the adjuster will deny your request and ask that you correct what you sent. Regardless of whether or not the adjuster will accept the medical treatment, providing the correct documentation is the first step. Reasons they may not accept your request include:

  1. The bills and records are not legible (a bad printed copy cannot be read by the adjuster and can deteriorate even worse when faxing or scanning)
  2. You forgot to include medical records with your bill
  3. Pages of the billing statement or medical records are missing
  4. Bills do not include ICD-9 and/or CPT codes
  5. Bills and records do not include the dates of service, the facility name, or the facility location
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