MDNews - Cleveland-Akron-Canton

Med Pay Becomes Primary By Christopher M. Huryn P ATIENTS INJURED IN automo- bile accidents may possess two forms of insurance to pay for treatment: health insurance and automobile insurance medical payments coverage ("med pay"). Until recently, providers questioned whether they could bill services to med pay when a patient also had health insurance. To bill or not to bill med pay? The uncertainty arose from Ohio Revised Code ("R.C.") 1751.60(A), which states that "every provider or health-care facility that contracts with a health insuring corporation to provide health-care services to the health insuring corpora- tion's enrollees or subscribers shall seek compensation for covered services solely from the health insuring corporation and not, under any circumstances, from the enrollees or subscribers, except for approved co-payments and deductibles." Rather than risk violating R.C. 1751.60(A), providers would bill the patient's health insurer but not bill the patient's med pay. The Ohio Supreme Court answers the question. On August 20, 2011, in King v. ProMedica Health System, Inc., 2011-Ohio-4200, the Ohio Supreme Court resolved this issue. In this case, Virginia King received treatment from ProMedica Health System for injuries arising from an automobile accident. Although King was covered by Aetna and provided her health-insurance information, ProMedica billed her auto- mobile insurance, Safeco Insurance, for services rendered. ProMedica received payment from Safeco, and did not ask King to make any payment. King filed suit alleging ProMedica violated R.C. 1751.60(A) by billing her automobile insurer instead of her health insurer. The Ohio Supreme Court ruled that ProMedica did not violate R.C. 1751.60(A). The Court noted that this statute prohibits seeking compensation from the insured (i.e., patient) of a health-insurer with which the provider has a contract. However, the Court reasoned, compensation paid by King's med pay insurer, Safeco, did not equate to compensation by King herself, because ProMedica did not ask King to make any payment. Thus, the prohibitions in R.C. 1751.60(A) do not apply when a provider bills the auto insurer instead of the health insurer, so long as the provider does not then ask the insured patient for payment. Going forward. The King decision does not mandate that providers bill a patient's automobile insurer, and a provider can still choose to only bill the health insurer. However, Ohio law is now clear that providers can bill a patient's auto insurance rather than medical insurance. Providers are encouraged to discuss with their counsel whether the King decision warrants changes to their billing policies for motor vehicle accidents. Christopher Huryn is a partner at Brouse McDowell in Akron, and practices in the fi rm's Health Care Group. n Continued from Page 50 Orthopaedic and Rheumatologic Institute. He is also chairman of the Professional Conduct Committee for Cleveland Clinic and serves as an orthopaedic foot and ankle consultant for the Cleveland Browns, Cleveland Indians and Cleveland Cavaliers. In addition to his clinical responsibilities, Dr. Donley is active with research, education and innovation. He teaches medical students, orthopaedic residents, and orthopaedic foot and ankle fellows. He has published more than 75 scientifi c articles and has made more than 200 presentations internationally, nationally and regionally. Dr. Weil is a neurosurgeon who specializes in neurosurgical oncology with particular expertise in the surgical and radio- surgical treatment of patients with pituitary tumors, as well as benign and malignant tumors of the brain. In addition to his new role with Lakewood Hospital, Dr. Weil will continue to see patients, perform surgeries, conduct research, and remain active in teaching medical and graduate students as well as residents and fellows in training. He is a member of the Cleveland Clinic Board of Governors. Dr. Weil, who joined Cleveland Clinic in 2004, is director of the Pituitary & Neuro-endocrine program in the Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center within Cleveland Clinic's Neurological Institute. He is the Melvin Burkhardt Chair in brain tumor research. n NOVEMBER-DECEMBER 2011 MDNEWS.COM MD NEWS Cleveland-Akron-Canton | 51

• Cover