QUESTION #121: If a physician is treating family members, can they still bill the insurance company?

ANSWER (01/12/06): According to CMA ON-CALL document #0160, "Treatment of Relatives (or Oneself)," CMA is not aware of any law that requires physicians to treat themselves or their relatives free of charge. However, some insurance companies may have included language in the health insurance policy that limits the insurance company's obligation to reimburse physicians who treat their relatives or themselves. Medicare expressly excludes coverage for treatment of a physician's "immediate relatives." If the language of the policy excludes coverage for treatment rendered by physicians to themselves or to those who are related to the physician, the California courts may uphold the insurance company's right to withhold reimbursement. Without seeing the contractual language in the policy, it is impossible to determine whether any particular policy excludes coverage. For more information, please review CMA ON-CALL document #0160.

CMA ON-CALL: #0160, "Treatment of Relatives (or Oneself)" — available free to members at http://www.cmanet.org