Your health insurance contract may have a RAP Clause that can save you money
A serious injury from an auto, motorcycle, trucking or bicycle accident may necessitate a surgical procedure to make the patient whole again. Under the best of these circumstances, a non-life threatening injury would give the injured party an opportunity to seek a consultation with a surgeon “in-network” under their health insurance plan. When a course of treatment was agreed upon, the surgeon would schedule the operation with an in-network facility. But how many other physicians and healthcare professionals are performing services on your behalf while you are under anesthesia? You may be surprised when the bills start rolling in.
It takes a team of physicians and healthcare professionals
While you are in the operating room and during your hospital stay, a team of professionals work side-by-side with your surgeon providing supplemental services that make a successful surgery possible.
Your anesthesiologist has probably been hand-picked by your surgeon who chose him/her because of a good working relationship and his/her availability on the date of surgery. Many anesthesiologists do not contract with health insurance carriers because they are not usually chosen by the patient and therefore “in-network” status is not a consideration. The same holds true for assisting radiologists (the physician reading and interpreting your images) and pathologists (one who checks organs, tissues and bodily fluids).
Many, though not all health insurance policies, have a clause within the policy that pays “in-network” rates for “uncontrollable” out-of-network providers, meaning you can’t control who comes in to perform the service. The RAP (Radiologist – Anesthesiologist – Pathologist) Clause within many health insurance policy descriptions may also be called the PARE (Pathologist – Anesthesiologist – Radiologist – Emergency Providers) Clause. Under the PARE clause, you may be additionally covered for emergency services and trauma providers as in the case of life-threatening injuries resulting from an accident.
If your surgeon and hospital facility are in-network, and your surgeon has received pre-approval under your health insurance plan, you have every reason to expect you are within policy coverage. If an “uncontrollable out-of-network provider” bills your health insurance company before your insurance carrier has received your hospital bill, your insurer will probably decline or pay their bill at out-of-network rates. In this case, it is important that you file an appeal under the RAP or PARE clause with your insurance provider and immediately notify the “uncontrollable provider” that an appeal has been filed.
Experienced Accident Attorneys Helping You
An experienced personal injury attorney will negotiate to secure a full release before a settlement is made. The attorneys of Ward & Ward, Charlie Ward and Don Ward, have more than 90 years of combined experience in dealing with personal injury and wrongful death claims. We understand personal injury law and stay on top of Court decisions to successfully resolve our client’s legal claims. You may also be interested in our firm’s article about Surprise Billing.
Call Charlie Ward today for a free, no-obligation consultation at 317-639-9501.
*Ward & Ward Law Firm is a contingency law firm and does not get paid unless we recover for our clients. This article is not intended as legal advice. If you or someone you know has received a Surprise Billing, you should discuss it with your attorney before taking any action. Each situation is unique and only your attorney may give you legal advice.