What’s third party, why do so many doctors refuse to take it, and how do I handle this situation?
Few things related to auto accidents confuse people more than this. But both the definition and the reason doctors, by and large, refuse to file third party is really quite simple, as is the solution to the problem.
First, the definition: third party is simply when you want to file on someone else’s insurance.
Second, why do so few doctors file third party? I was in an accident and I don’t want file on my insurance. The other guy’s insurance said they’d pay. What’s the problem?
I worked at a clinic in a Dallas suburb for 15 years, and several times a week, insurance companies would approve treatment for the patient, even giving us a claim number, but when they received the bill from us, which was always beyond reasonable, the insurance often refused to pay. Because it wasn’t the patient’s insurance, neither the patient nor the doctor had much “clout” with the insurance company. The doctor was often the one who took the loss – often, a complete loss.
So what’s the solution?
The very best solution is just to use your own auto insurance (health insurance usually won’t pay – more on this later). PIP (personal injury protection) is the very best insurance you can possibly have, and in Texas, unless you have signed a statement with your auto insurance declining PIP, if you have full coverage, you have PIP. There’s rarely a deductible, no co-pay, and it doesn’t affect your premium. Many, although not all of our doctors, accept PIP.
Second option: occasionally, your health insurance will pay, although our doctors offices will have to verify it before you come in for your appointment. In virtually all of these cases, though, your health insurance will simply bill the responsible auto insurance for reimbursement, so there’s really not a good reason to go this route unless, of course, you don’t have PIP. In addition, using health insurance will leave you having to pay a deductible and/or co-pay.
A third option is to get legal representation. We can recommend law firms that abide by the highest standards of ethics. In fact, no one who belongs to Metro Doctors Group will work with an attorney who is known for questionable behavior. So if you’re planning on taking this route, be sure and check with us first. There are attorneys we simply will not work with.
Finally, we do have a few – a very few – doctors in some areas of the Metroplex who will file third party. Depending on the insurance company and our doctors’ past experience with each one individually, that’s sometimes a possibility.
If you have any further questions, Joe and I are always here to help in every way possible. We work with all kinds of doctors and many other health professionals throughout the Metroplex. Our goal is to be the Rolls Royce service in the field of health care. With us, you’ll always have the most personal and careful attention. We’ll offer you what no other referral service offers – a personal recommendation to health care professionals we know and trust.
Mary Blye Howe
Metro Doctors Group
www.MetroDoctorsGroup.com
214-499-6468