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The following is a list of other miscellaneous scenarios where a claim is not paid or not fully paid that CMA can handle on your behalf. (These scenarios are simply representative and not meant to be exclusive by any means.)

Coordination Of Benefits
Liability Of State, County, City Or Municipality For Treating Their Indigents
Payment For Prisoners Taken To A Hospital By Law Enforcement Officials
Auto Accident Liability
Hospital Liens
Usual And Customary Charges
Stalled Claims
Refunds
 

 

Coordination of Benefits
When two or more insurance companies insure the same person and the companies are each disputing which one should pay first. In addition, occasionally an insurance company will withhold payment until they confirm that their insured was not covered under another insurance policy.

 

Liability Of State, County, City Or Municipality For Treating Their Indigents
When a government entity brings an indigent to a hospital for treatment, often it is very difficult to get the government entity to admit financial responsibility for such treatment, but there are often specific statutes and/or case law that control such a situation.

 

Payment For Prisoners Taken To A Hospital By Law Enforcement Officials
When a law enforcement agency brings an arrested individual or prisoner to a hospital for treatment, usually to the emergency room. Payment for such a situation often depends on the statutes and case law specific to the state and whether the patient is considered being in police "custody".

 

Auto Accident Liability
When the patient was injured in an automobile accident where the patient was not at fault. Payment can often be obtained out of the settlement reached by the patient with the at-fault party. (Also see hospital liens below.)

 

Hospital Liens
Related to auto accident liability cases set out above, many states have specific laws which enable a hospital to file a "lien" against any settlement proceeds of the patient from the patient's liability claim. Laws vary from state to state as to how a lien must be filed, the time requirements for filing such a lien, what protection a filed lien gives the hospital and what recourse a hospital has if the patient settles without resolving the lien.

 

Usual And Customary Charges
Insurance companies often reduce payments based on what they allege should be the usual and customary charges for particular services for the area or region.

 

Stalled Claims
Many times insurance companies will simply present excuse after excuse to not pay a claim. By itself each individual excuse may appear reasonable, but when the overall pattern is reviewed it becomes obvious that the insurance company is simply stalling.

 

Refunds
When an insurance company asks for a refund of a payment previously made on a claim. CMA can handle these requests on a hospital's behalf, with no fees being due until the insurance company is no longer pursuing the refund request.

 

Contact Information

Christopher E. M. Maldonado - Director

    Telephone         602 308-1862

    Address            5045 North 12th Street Suite 136

                               Phoenix, Arizona 85014

 

 

 


Copyright © 2000 Center for Health Insurance Claims Advocacy
Last modified: May 14, 2008