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Motor Vehicle Accident Guidelines

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MVA Guidelines Form

We understand that you have been in an auto accident. Please answer all questions completely and return the accident information within the first 7 days after you are discharged from BAPTIST HEALTH. If we do not receive this information, you will be directly responsible for the entirety of the cost of your hospital stay.

This accident information will allow BAPTIST HEALTH to correctly bill the auto insurance that is responsible for the medical expenses due to your motor-vehicle accident. Our office will process the information in order to ensure that the medical claim is billed correctly. Without complete accident information and documentation, you will immediately begin receiving statements for your remaining balance.

For billing purposes, you will need to provide both your auto insurance and medical insurance information (even if another party is at fault). Per hospital policy, your auto insurance will be billed first. After they have responded via payment or denial, we will then bill your medical insurance for any remaining balance. Your auto insurance will then resolve any issues outstanding with other responsible parties and their insurance carriers. If there is an attorney involved, all contact information must be provided. Unless your accident is work-related, we are unable to bill any third party or their insurance without written consent.

If you have any questions, please call Patient Financial Services at (501) 202-3904 or (501) 202-3933.

For Direct Physician Referral & Appointments: 501-227-8478 or 1-888-BAPTIST(227-8478)

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