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Four Words You Don't Want to Hear Your Doctor Say -- "We'll Bill the Accident"

It sounds innocent enough, but those four words can cost you thousands of dollars at the end of your case. Let’s explain ….

If you have health insurance, your doctor has probably signed an agreement with your health insurer where he agrees to treat everyone who is covered by your health insurance for a discounted amount. Many times, you will get bills in and see that a large portion of your bill was written off because of your health insurance, that your health insurance made a payment to your doctor, and that after the write off and the payment, you have only a small balance left to pay yourself.

From the standpoint of the doctor, this means that he receives only a small payment on the full amount that was billed. In practice, a doctor may issue a bill for $1,000 and receive cash payments from you and your health insurer that may amount to $400, and this represents payment in full of the $1,000 bill for services. In practice, doctors, hospitals, and health care providers almost never get paid the full amount they bill for services.

When a doctor says, “We’ll bill the accident,” what this means is that they will take steps to get paid from either your medical payments coverage (if any is available) or put a lien on the settlement of your case. When a doctor or hospital puts a lien on the settlement of your case, that means that they have a legal right to be paid out of the settlement proceeds of your case. In fact, if they notify the other driver’s liability insurance carrier, they will often put the doctor’s name on your settlement check as a payee.

What difference does it make to you?

When a doctor puts a lien on your settlement, he may have a right to be paid the full amount that he billed, even if you have health insurance. This means that if he issues a bill for $1,000, he may have a right to be paid the full $1,000, even though he would have received cash payments of $400 had the bill been submitted to your health insurance. Guess where the $600 difference comes from? It comes out of your pocket.

There are many reasons that the phrase, “We’ll bill the accident,” are words that you do not want to hear, including:

• It will almost always end up costing you more money to receive care, sometimes significantly more money;
• Your doctor is trying to profit off the fact that you were involved in an accident; and
• Your doctor is cheating you out of the benefits of the health insurance that you worked for.

However, let me tell you about a former client named Lucy to understand why you really don’t want to hear your doctor say that:

Lucy was involved in a car accident which happened when another driver pulled out of a parking lot in front of her. She lost control of her car after she was hit and struck two other vehicles stopped at the intersection and then crashed into a light pole. A friend recommended that she talk to the lawyer who handled her bankruptcy. The bankruptcy lawyer sent her to a lawyer in his office who told her to see “his doctor” who he “had a relationship with.” When she went to see the doctor, he said that they would “bill the accident.” The doctor ordered an MRI of her knees because she was complaining of pain in the knees. The radiologist (a doctor who does nothing but review films of x-rays. MRI’s, and other diagnostic tests) read the MRI films as being normal. However, the doctor her lawyer sent her to said that he saw some torn cartilage and recommended that she have arthroscopic surgery on her knee. The surgery was done at an ambulatory surgery center. Most surgeries like this cost between $16,000 - $20,000. The bill for Lucy’s surgery (keeping in mind that the radiologist thought there was nothing wrong with her knees to begin with) was approximately $64,000. Not surprisingly, the case was referred to the “special investigations” (sometimes referred to as the “fraud”) unit, and we had substantial difficulty in getting the case settled after she fired the lawyer who sent her to “his” doctor.

The moral of the story is this: you open yourself up to substantial abuse when you agree to have a doctor “bill the accident” when you have health insurance. Not only can it cost you thousands of dollars out of your own pocket, but you may be subjected to more expensive (and perhaps unneeded) medical care than you would otherwise.

The Law Offices of
Barry G. Doyle, P.C.
5215 Old Orchard Road
Suite 710
Skokie, IL 60077
Phone: 312.263.1080
Fax: 312.263.0153

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