North Carolina Policyholders: Notice to policyholders recently affected by severe weather. 

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Can You Treat a Family Member and Bill Their Insurance?

While it may be tempting to tap into your family to increase your client base, it's illegal to do so and bill their insurance under a 1989 statute called Stark Law.

The treatment of family members has come under increased scrutiny lately. All insurances forbid treatment of family members and submitting claims for reimbursement. 

The treatment of family members falls under General Exclusions from Coverage under Medicare [PDF]: “No payment will be made for items or services for a family member when the charge is from an immediately related provider, any of their associates or their professional corporations.”

Additionally, private third-party payers include regulations around this topic in your provider agreement with them. Review your provider agreement and call provider relations with any questions.

Who is included?

Stark Law’s definition of a family member is broad and extends to:

  • Spouses
  • Parents
  • Children
  • Siblings
  • Step-parents
  • Stepchildren
  • Step-siblings
  • Children-in-law
  • Siblings-in-law
  • Grandparents
  • Grandchildren
  • Spouses of grandparents
  • Spouses of grandchildren

For more information on Stark Law, please check with your state and national associations, third party payers’ provider relations resources, or your legal counsel.

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