Act 6- Treating Patients After an Automobile Accident
2022
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Quick Tips for the Dental Office
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Act 6- Treating Patients After an Automobile Accident
Act 6 of 1990 limits the amount of payment that health care providers can receive when treating injured automobile insurance policyholders. Healthcare providers are required to accept payment from the insurance company as payment in full, and may not balance bill the patient for the remaining balance.
The Medicare fee schedule is used to determine reimbursement levels, and if the charges that occur cannot be calculated under Medicare, payment cannot exceed 80 percent of a provider’ s usual and customary fee. Services must be billed directly to the insurer and not the insured.
Act 6 is applicable in all cases where services are rendered by a provider licensed by the Commonwealth of Pennsylvania.
When a patient is involved in an automobile accident, does a dentist have any recourse in recovering the unpaid amount of a bill after the bill has been paid by an insurance carrier pursuant to Act 6 of 1990?
Not unless benefit limits have been exhausted. The Pennsylvania Motor Vehicle Financial Responsibility Act( Act 6 of 1990) contains provisions limiting the amount of payment a provider can received for providing treatment to an injured person when that injury is covered by liability or uninsured and underinsured benefits or first party medical benefits. The Act states that the provider shall not require, request or accept payment for the treatment, accommodations, products or services in excess of the specified amount. The Act does not contain any qualifying language limiting this restriction to collection from patients. Thus, the Act appears to prohibit the collection of payment in excess of the specified amount from any source.
2022