Define and explain the term "common accident provision."
What will be an ideal response?
Answer:
A common accident provision states that only one deductible, under Major Medical, will be taken for all members of a family involved in the same accident. After the one deductible, remaining deductibles will be waived on all other members for expenses incurred for that accident only.
As a medical biller or health claims examiner, it is important to be aware of where each member of a family stands in relation to their deductible payments. The patient with the most charges during the year has probably gone the farthest toward meeting their deductible. Also, if the insurance carrier has previously made several payments, the deductible has usually (though not always) been satisfied.
If more than one member of a family is being treated, many insurance carriers will take the single deductible from the claim that comes in first. If several claims for the family come in at the same time, the deductible is taken from the patient who owes the most on their deductible.
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