When you submit your medical bills and records for MedPay reimbursement, the adjuster will a) reimburse the expense, b) deny the expense, c) partially reimburse the expense or d) ask for additional documentation. Your best hope is that everything has been submitted successfully and that the MedPay adjuster will reimburse you for each of your medical bills.
Once you have submitted all of your medical bills and records to the MedPay adjuster, they will typically take an average of 2 to 4 weeks, depending on the insurance company or the adjuster, to review the request, process the request and print the check if the expense is being reimbursed. If you are looking for a more specific timeline, it is a good idea to ask the adjuster for turnaround times for MedPay reimbursement funds.
It is important to be patient as there are usually several different departments involved with each step of the reimbursement process. The adjuster not only has to review the bills and records to make sure the treatment is relevant, but they must also ensure that the bills are reasonable. This review may require approval by a supervisor or by a group of supervisors called a “committee.” Some treatment may even need to be reviewed by a medical doctor that has been retained by the insurance company to ensure all treatment reimbursed was medically necessary and appropriate. Once the treatment has been approved, the check has to be physically drafted by a separate department, which can take up to a week, and mailed to the appropriate location. Remember that this can, and will, take some time.
If it has been over a month, however, and you have not heard back from the adjuster about your reimbursement, it would be a good idea to give the adjuster a polite follow-up call to check the status of the claim. If you have received a call from the adjuster about the documents you submitted, be sure to answer the call or return the call in a timely manner so that the adjuster can process your reimbursement as quickly as possible.
Medical Payments reimbursement is designed to cover medical expenses related to your accident. Assuming you do not have any medical liens, it is our recommendation that any MedPay checks you receive be used to pay off outstanding medical bills. The goal of an insurance claim is to get back what an accident cost you so that once you have reached a final settlement, you know that everything is taken care of and that you do not owe any money to any other medical provider. However, this will only be the case if you make sure to pay off your bills from your medical providers.
If you have already paid all of your medical providers, then what you receive is a true reimbursement check, meaning you can do with it as you see fit. Before you do anything with the money, you should contact each medical provider and confirm that you owe a $0 balance. It’s a good idea to get that confirmation in writing.
When the MedPay adjuster sends you the check, they should also include a document called an Explanation of Reimbursement (EOR), which contains an explanation of what was reimbursed related to your Medical Payments Claim. This document will list information relevant to your claim, such as the claim number, adjuster information and date of accident. It will also specify details about the reimbursement and should correlate with a Medical Payment check.
For example, if you submitted medical bills and records for a visit to the emergency room that cost $1,300 and have a MedPay limit of $1,000, you may receive a $1,000 check in the mail along with an EOR. This EOR should indicate the medical provider who provided the service related to the accident (the emergency room, in this case), the date of service received (or the date you went to the emergency room), the total amount charged (the $1,300) and the total amount reimbursed (the $1,000). In this case, you will probably see a note that $300 was not reimbursed due to the Medical Payment Reimbursement maximum being reached. This is to be expected and is nothing to be concerned about.
If you only have $1,000 in coverage, you cannot get reimbursed for that remaining $300 from your MedPay coverage. Depending on the company, you may get a letter in the mail a few days letter called an “Exhaustion Letter,” stating that your MedPay limit has been exhausted. This means the adjuster has paid all they would have to pay for your claim and will be closing your claim.
However, if you have a $2,000 MedPay limit in that same scenario, your EOR will likely show that $1,300 was charged and $1,300 was covered. This means that you still have $700 remaining in MedPay coverage. You should get EORs for each check you receive, and it is a good idea to verify that each check matches its EOR. If for some reason your EOR says you are going to be reimbursed $1,300 but you are only reimbursed $1,200, there may be a check printing error and you should call your adjuster immediately.
Depending on the company, your adjuster may send an Explanation of Reimbursement letter before your check, after your check or with your check. If for some reason you get a check and do not get an EOR letter, call the insurance company and request that one be sent to you immediately.