The Basics of MedPay Reimbursements

Medpay, or Personal Automobile Medical Payments, is a form of liability insurance coverage that pays all or part of an insured driver's medical claim for injuries sustained as a result of an automobile accident and pays regardless of fault.

Med-Pay FAQs

Emergency physicians
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Who Is Covered by Med-Pay?

Depending on the type of coverage the insured has, Med-Pay will usually cover medical expenses for the driver and its passengers of the covered vehicle. The medical expenses incurred by the injured driver and/or passengers in the other vehicle are paid by a different method.

What Medical Services are Billable to Med-Pay?

Does Med-Pay Take the Place of Health Insurance?

No. Most Med-Pay policies only pay up to $5,000 per person per accident although some policies can pay up to $100,000 per person. When submitting auto claims for payment, follow this process:

  1. Bill the Med-Pay as the primary insurance
  2. Only file health insurance primary when:
    • The patient will not provide the Med-pay insurance coverage information
    • Prompt payment, or payment within 30 days, is not made by Med-pay (Follow Conditional Payment Guidelines for Medicare patients)
    • Med-Pay denies the claim in full
  3. File the health insurance as secondary when Med-Pay makes a payment toward the claim but benefits do not cover the total amount of the claim

Does the Medical Office Have to File a Med-Pay Claim?

The Medical Office can set its only policies and procedures in place determining whether to file Med-Pay claims. There is no law prohibiting or enforcing Med-Pay billing, however, according to MSP Guidelines Medicare does require that when the patient has Medicare coverage that all attempts be made to bill the Med-Pay prior to filing Medicare.

Medicare Secondary Payer or MSP refers to Medicare benefits when Medicare is not the primary insurance. Medicare requires all health care providers to know how to determine when Medicare is the primary or secondary insurance for their Medicare patients.

Can the Patient Be Billed Directly for Treatment?

Many circumstances may occur that the Medical Office should require the patient to pay cash upfront.

  • The Medical Office does not have a signed lien and the patient has hired an attorney
  • The patient, Med-Pay carrier, and/or the patient's attorney refuse to negotiate a payment arrangement prior to settling the case.
  • The patient refuses to sign a consent to assign benefits for payment to be sent directly to the Medical Office
  • The patient may incur high medical expenses due to major surgery or recurring visits such as physical therapy, chiropractic visits, etc.

Auto Insurance Laws

Emergency Physicians

Auto Insurance laws differ from state to state. Before taking any financial action or developing a financial policy regarding patients involved in auto accidents, become very familiar with your state's statutes regarding auto claims. Some states have "no-fault" insurance laws that may possibly impact your decision regarding Med-Pay. Medical Office and all material provided are designed to provide accurate and helpful information. Every reasonable effort has been made to ensure the accuracy of the information provided. However, all appropriate sources should be verified as the author is not liable and makes no guarantee or warranty; either expressed or implied that the information compiled or presented is error-free.

Although every effort is made to keep articles up-to-date and current, information is subject to change without notice. All users need to verify information with the CMS, DOJ, OIG, and associated local, state and federal governmental agencies. The user assumes all risk and liability with the use and/or misuse of this information.

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