Medical Reports for Insurance Companies

Providing a medical report or other medical information about a patient to an insurance company is an uninsured service for which you are entitled to direct bill. But do you bill the patient or the insurance company? We recommend that you take the following steps:

Requests from Insurance Company

If the request comes directly from the insurance company (provided the request includes an appropriate written patient authorization), inform the insurance company in writing:

  1. that there will be a fee for the service;
  2. what that fee will be; and
  3. that you require written confirmation from the insurance company, before you prepare the medical report/information, that the insurance company will pay your fee promptly after delivery of the medical report/information.

Requests from Patient

If the request comes from your patient, bill the patient, not the insurance company.

This applies in BOTH of the following cases:

  1. The patient attends at your office and requests that a medical report/information be provided to his/her insurance company.
  2. The insurance company sends you an authorization, signed by the patient, to provide the insurance company with a medical report/information, AND THE AUTHORIZATION STATES THAT THE PATIENT IS TO BE RESPONSIBLE FOR THE COSTS OF THE SERVICE.

In either case, inform your patient (preferably in writing):

  1. that there will be a fee for the service;
  2. what that fee will be; and
  3. that you require written confirmation from the patient, BEFORE you prepare the medical report/information, that the patient will pay your fee promptly after delivery of the medical report/information to the insurance company.

If your patient takes issue with whether they (as opposed to the insurance company) should be responsible for the payment of your fee, advise your patient that this is a matter to be worked out directly between the patient and the insurance company. Ask that your patient contact you after they have discussed the matter with their insurance company to advise you as to the outcome of the discussion, and, thereafter, you should follow the appropriate steps set out above.

To assist you in determining your fee for the provision of a medical report/information to an insurance company, consult Doctors Manitoba’s publication, Billing for Uninsured Services – A Practical Guide for Manitoba Physicians . Hard copies may be obtained from the Doctors Manitoba office. Phone 985-5851 or 1-888-322-4242. E-mail uninsuredguide@docsmb.org.

Questions?

Allison Crolly
acrolly@doctorsmanitoba.ca
(204) 985-5856

Updated: December 2016