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 .
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