Insurance Management FAQs

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 (75 Pa C.S.A. § 1797)?

No, unless benefit limits have been exhausted. The Pennsylvania Motor Vehicle Financial Responsibility Act, in Act 6 of 1990, contains provisions limiting the amount of payment a provider can receive 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.

As further evidence that the capped amount was intended to be the sole payment, there are a few specified exceptions that set forth when a provider may turn elsewhere for payment. For example, when benefit limits of a policy have been exhausted, a provider may bill the insured for the remaining services not paid under the automobile insurance policy. In such a situation, the provider may bill another insurance policy if it exists, and payment shall be made under the terms of that policy, without regard to the medical cost containment provisions of Act 6. Finally, if no portion of a provider's bill is payable under automobile insurance coverage, the payment limitations no longer apply, and a provider may directly bill the insured or other insurance carrier as it had prior to passage of Act 6. The fact that the Pennsylvania Code sets forth instances in which a provider may turn to other sources for payment, indicates that a provider should not turn to other sources in other situations not authorized by the Act.

Answer is informational only and not intended as legal advice. Answer may contain excerpts from
The ADA Practical Guide to Frequently Asked Legal Questions.