How to Submit Your Own Bill
For car accidents, work injuries and out-of-network health plans. We hand you everything your carrier needs, you send it in, and they pay you back. Here’s the whole thing, start to finish.
Which one are you?
Hurt in a car accident
Your auto policy pays you back for your care, even if the wreck wasn’t your fault.
Car accident steps ↓Hurt at work
An accepted work injury is covered by comp. Same steps, different carrier.
Work injury steps ↓Out-of-network health plan
Your plan may pay you back for out-of-network care. You send the claim yourself.
Health plan steps ↓How it works, every time
Four moves, the same for all three. You stay in charge of your own claim from start to finish.
- 1Your visitYou pay at the visit
- 2We hand you the formsItemized bill + visit note
- 3You send them inTo your adjuster or plan
- $You get paid backStraight to you
If your forms aren’t ready at your visit, allow up to two weeks. We’re a small office and pull paperwork together every two weeks. You pay our regular cash rate.
See what you’ll get
After each visit you get your itemized bill on the CMS-1500, the standard claim form every auto and comp carrier already knows, along with your visit note. Here’s a sample with made-up details, so you know exactly what you’re sending in.
- 1Box 10b: auto accident, yesTies this visit to your car accident claim. A work injury marks 10a instead.
- 2Box 13: left blankBlank means the payment comes to you, not us.
- 3Box 14: the day it happenedThe date of your accident or injury.
- 4Box 21: what we’re treatingThe diagnosis codes from your exam.
- 5Box 24: each service and its priceEvery part of the visit, one line each.
- 6Boxes 27 to 29: you already paid$70 charged, $70 paid. The carrier reimburses you.
Think of your claim like a card
Every claim has limits, whether anyone spells them out or not. So picture yours as a card with a set amount on it and an expiration date, and plan your care around it.
Nobody will really hand you a card, and a lot of people assume their claim is good for years. But in our experience, the longer a claim runs, the more questions the carrier starts asking about whether something else happened along the way. Plan like the clock is short, and you don’t give them a reason to wonder.
You’re the one holding the card. If you need more time than that, that’s when it’s worth talking to a lawyer.
Car accident
Your auto policy has a set amount for medical care. In Pennsylvania it’s at least $5,000. Picture that card, about four months long.
Work injury
Comp doesn’t set a dollar amount, but think of it the same way: a card with a set amount and an expiration date.
Health plan
Plans have their own limits: a deductible, a cap on visits, a window to file. Same card, different numbers.
Your benefits go further
Your bill from us now shows our $70 cash rate. That’s less than we used to bill your auto policy for the same visit, so the same card stretches across more visits.
About 50 visits out of a $5,000 card.
About 71 visits out of the same $5,000. That’s roughly 20 more visits of care.
Each dot is one visit. Based on a $5,000 medical benefit, the Pennsylvania minimum; your policy may carry more. The old figure is what a typical auto visit was billed at here.
Why you hold the claim
The old way put three people in the middle of your claim. This way it’s a straight line from you to your carrier, with us standing right behind you.
Before you call your adjuster
The first call sets up everything after it. Know how the process works before you hang up, and you won’t be guessing later. Ask these, and write the answers down.
The exact email, fax or mailing address, and whose attention it goes to.
A check or direct deposit, and how long it usually takes.
Tell them you’re paying your provider yourself, so the reimbursement should come to you.
Any forms of their own, your visit notes, a wage or work form.
Know your number. That’s your card.
Your adjuster’s name, direct phone, email and fax, plus your claim number.
We help you set it up
Bring your adjuster’s answers to your visit and we’ll go through it with you, so there’s nothing to worry about.
Want your adjuster copied?
Send us their email and we’ll CC them on everything we give you.
The only difference: we’re not waiting on them to get paid. We’re helping you get reimbursed.
Your auto claim
In Pennsylvania, your own auto policy usually pays you back for your care, even if the wreck wasn’t your fault. Have these handy for your forms.
| What | Where to find it |
|---|---|
| Your auto insurance company | Your insurance card |
| Your claim number | Your carrier gives it to you when you open the claim |
| Date of the accident | You know this one |
| Your adjuster’s name, phone, email and fax | Ask for all four the first time you talk |
Your workers’ comp claim
Tell your employer right away, then have the same details handy: the comp carrier, your claim number, the date you got hurt, and your adjuster’s name, phone, email and fax.
More about work injury care →Out-of-network health insurance
Sending it yourself
You pay at the visit, we give you an itemized bill with the codes your insurer needs, and you send it to your plan’s out-of-network claims. If you haven’t heard back in 30 days, call them. Claims really do get lost, and a polite follow-up moves things along.
Rather use your health insurance for an injury?
You can. Just decide early: health plans only give us a limited window to bill, often under 180 days. And it’s one or the other for each visit. We can’t bill your health plan and then have you send the same visit to your auto or comp carrier to cover the copay.
Keep notes at home — we’ll pull them together
Part of your care is noticing what’s hard, right when it happens: can’t sleep on that side, can’t sit through a shift, can’t turn to check traffic. No schedule. Catch it when you notice it, and forget about it.
Say It Out Loud
iPhone: open Notes, tap the microphone on the keyboard, and talk. Android: do the same in Google Keep. Or tell your AI app what happened and ask it to type it up with today’s date.
Add When and What You Were Doing
“Oct 8, 7 AM — couldn’t turn my head backing out of the driveway.”
Keep One Running Note
Add to it whenever something comes up.
Email It to Us
Send it to office@smithcw.com with your full name and “notes” in the subject line. Typed notes, voice memos, photos and documents all work.
We Pull It Together
We organize your notes, match them to what we found on exam and what we’re treating, and put a clean report in your file. Then we hand it back to you to send in with your forms.
Have an attorney?
Let us know. We give your records to you, so you know where they need to go and can hand them to your lawyer.