Oftentimes, clients will ask who should be paying for their medical bills they incur for treatment of their injuries, when they are injured due to someone else’s negligence. Often times, clients will ask “shouldn’t the other person’s insurance pay for my bills?” or “why is my health insurance paying the bills when I was not at fault?”The simple answer is that when a client has health insurance that can be billed it usually puts more money in the client’s pocket at the time of settlement.
When you incur medical bills due to treatment that is related to a wreck that is not their fault there are several options as to handling of that bill. These include:
Your auto insurance, through a medical payments (MedPay) policy will kick in and pay up to a certain amount of your medical bills;
A lien from the medical provider, meaning that they file a lien with the Court saying that they are entitled to reimbursement of their full bill from any settlement proceeds that you may receive; or
Have the provider bill your health insurance.
When health insurance is billed, they usually do not pay the entire bill. Each provider has their own agreements with different health insurance providers, and already have pre-agreed upon discount and adjustment amounts. This usually means, that in exchange for the provider being able to bill the health insurance company, they agree to write off the remaining balance, minus whatever co-pay or deductible might remain for the client. For example, let’s say that a client has United Health Insurance through the employer. They incur a $10,000 hospital bill the day of the wreck. The insurance company may pay as little as $1,500 of that bill, and the rest would be a contractual adjustment for the provider, meaning they would write off the remaining balance, except for whatever co-pay or deductible may be due.
MORE MONEY FOR THE CLIENT
This puts more money in the client’s pocket at the end of settlement. When a client has finished treatment, and we are ready to send over a demand package to the adjuster for the auto insurance, then we get to count and include the FULL amount of any medical bills related to the wreck. BUT we only have to re-pay the health insurance company the amount that they actually paid out. Any adjustments or discounts do not have to be reimbursed. In the earlier example, the $10,000 hospital bill would be submitted to the auto insurance company for consideration in the demand for the client. You get compensated based on the full amount of the bills submitted. But we would only have to repay United Health the $1,500 they actually paid. The $8,500 difference is part of what goes in the client’s pocket. Often times, your attorney has cultivated relationships with the various health insurance companies out there, and through their negotiations, they can often get the amount owed to the health insurance company reduced, so that you put even more money in your pocket at the end of settlement.
PROBLEMS WITH MEDPAY AND LIENS
If you allow MedPay to pay your bills or allow providers to file a lien against you, then that amount is due in full, and they usually will not reduce the amount owed. Meaning, you are not getting as much in your pocket at the end of settlement. Some providers will try to tell you that because your injuries and treatment are due to a third-party, then they MUST bill any MedPay available, or ask you to sign a lien agreeing to pay them from any recovery. This is simply not true, and is just the medical providers way of trying to get reimbursed a greater amount than they would get paid by a health insurance policy. The providers know that if they bill health insurance, then they are only getting paid what the health insurance company chooses they will pay, and the rest is a write-off for the provider. Do not let them fool you. If you have health insurance, then be firm with any medical providers that you treat with, and make sure they have your health insurance information and make sure they are billing that insurance. You will end up with more money in your pocket at the end of settlement.
CALL REASONOVER LAW TODAY
If you or a loved one have been injured due to someone else’s negligence, then please give Reasonover Law Firm a call today. We can assist you with the process and make sure that you have all the information you need in order to put as much money in your pocket at the end of the day. Getting in touch with an attorney right after a wreck will allow them to answer all your questions and guide you as to the best course of action to get you the most money for your case. Please call us today at 615-241-0405 if we can help.
2323 21st Avenue South
Nashville, TN 37212