Commonly used EMS forms:
Ambulance Related Billing Information:
Providing Insurance Information
It is very important that we receive accurate and up to date information, regarding your insurance coverage. We will submit claims on your behalf to your insurance carrier(s), after you have received services from us. Insurance carriers require claims be submitted on a specific form or in a specific electronic format. By providing us with the insurance information, we can ensure that the claims are correctly submitted, which helps speed the claim processing and payment process.
Insurance information can be submitted using the form that you may have received in the mail or by the following methods:
Co-Pay and Deductible Amounts
These out of pocket amounts, are determined by your insurance company and are passed on to S.S.E.S.A. to collect as part of our total allowed payment for the services we provided. We have no control over these amounts and can not provide information on what your out of pocket amount may be for a particular service prior to submitting the claim, as each policy can have different patient out of pocket responsibilities.
Insurance Information Regarding Auto Related Accidents
If the car accident victim occupied the vehicle at the time of the accident, and that person has no car insurance in the household, you look next to the owner of the vehicle. If the vehicle owner has car insurance, that insurance company must pay benefits. After that, you look at the driver’s car insurance company.
If the vehicle owner or the driver does not have car insurance, then the accident victim must go through the State of Michigan and what’s known the Michigan Automobile Insurance Placement Facility, better known as Assigned Claims. This organization, which is managed by the state will assign an insurance company to handle the claim.
PIP Priority – Occupant:
Under the no-fault law, the order of priority for insurance if the victim was inside the vehicle is as follows:
1) Your own auto or *health insurance (client is the named insured)
2) Resident relative (a resident relative is not a live-in boyfriend or girlfriend, but is a spouse or typically a blood relative)
3) Owner of occupied vehicle
4) Auto insurance of driver of the vehicle, if none
5) Assigned Claims
If you were a non-occupant at the time of the accident – pedestrian or bicyclist – the rules are a little different. You still look to your own auto insurance or that of a resident relative first. After that, the owner of the motor vehicle involved is considered. If a motor vehicle involved in the accident is insured, that insurance company must pay benefits. If the owner of the vehicle does not have insurance, you next look to the driver of the motor vehicle involved.
If there still is no insurance, the accident victim must go through the Michigan Automobile Insurance Placement Facility (Assigned Claims) and the state will assign an insurance company to handle a claim.
PIP Priority – Non-Occupant:
1) Your own auto or *health insurance
2) Resident relative
3) Owner of motor vehicle involved
4) Driver of motor vehicle involved, if none
5) Assigned Claims
The rules for motorcyclists are a little different.
In a motorcycle accident, you don’t turn to your own car insurance first. Instead, the first place to look is the owner of the motor vehicle involved in the accident. If the owner has insurance, that insurance company must pay benefits. If the car owner doesn’t have insurance, then the car insurance operator/driver of the motor vehicle involved must pay. If there is no car insurance there, only then do you look to the car insurance of the operator of the motorcycle to pay benefits. If the operator of the motorcycle has no car insurance, then you consider the owner of the motorcycle.
After that, if there still is no insurance, the accident victim must go through the Michigan Automobile Insurance Placement Facility (Assigned Claims) and the state will assign an insurance company to handle a claim.
There are two important things to be remember about motorcycle accidents. First, to be eligible for no-fault benefits, the motorcycle must be insured. The owner of a motorcycle is injured and his or her bike is uninsured, you cannot get no-fault benefits.
Second, motorcycles are not motor vehicles under Michigan law. The Michigan no-fault law only covers claims when a motor vehicle is involved. Therefore, only motorcycle accidents were a car or truck is actually involved in an accident are compensable under the Michigan no-fault law. So if a motorcyclist loses control of his bike because of a slippery road, that person cannot collect no-fault benefits.
PIP Priority – Motorcycle
1) Owner or registrant of motor vehicle involved
2) Driver of motor vehicle involved
3) Operator of motorcycle
4) Owner of motorcycle, in none
5) Assigned Claims
* Michigan has what is called coordination of benefits, meaning the health insurer becomes primarily liable for medical expenses and, the no-fault auto insurer is not liable for the medical expenses that the health insurer is required to pay for or provide. Please consult with your auto insurance agent to determine if you have this type of coverage.
This information is merely a guideline and should not be considered legal advise in any way. Consulting with a qualified Attorney is always your best option.
For Questions Related to Ambulance Billing, Please Call: 800-399-9619