Barry: Yeah, one of the things that people commonly believe about getting their medical bills paid is that no matter what happens, their bills will get paid by the other driver’s insurance if they’re at fault. There are at least two reasons why that’s not necessarily the case.
One reason is that you actually may have more medical bills than the other driver has in insurance coverage. The other reason is that the causal relationship between the accident and the injuries that you’re claiming is something that is subject to being contested, and often is, so the bottom line is that the only time the other driver is going to be required to pay your bills is if you actually take the case to trial and get a verdict which includes your medical bills. Otherwise, it’s an item that’s subject to negotiations as part of the settlement, but the thing you have to keep in mind is that regardless of whether the other driver is paying your bills voluntarily, your doctors and your hospitals have a right to be paid in a timely way for the services that they provide to you.
Pam: So if the other guy’s insurance doesn’t have to pay, how do you make sure that those bills get paid and avoid having those things go to collections?
Barry: The thing that I always recommend to clients is to do their best to make sure that their medical bills get paid through their health insurance. Sometimes people have this innate resistance to having their health insurance pay for medical care that’s really due to the fault of someone else, and the thing that you really need to remember is that health insurance is one of the benefits that you work for. It’s there to really cover you in the event that you need medical care, and one of the times that people really need medical care is after an accident has happened.
Now, once those bills are paid, the thing that you need to keep in mind is that virtually every health insurance policy will have a provision in it that provides for reimbursement of the medical expenses to the health insurer. In other words, if you get a settlement, you’re going to have to pay back your health insurer for accident-related care. In the end, the burden for your medical care really does end up on the at-fault party, but you avoid getting sent to collections in the interim.
The other reason that you want to have your health insurer pay your bills is that your health insurer will have an agreement in place with just about every healthcare provider around to pay a discounted amount for whatever care it is that you require. The amount that you have to pay back to your health insurer is the discounted amount that they negotiated with your healthcare provided, so the bottom line is using your health insurance really is the preferred method for getting your medical expenses paid, even though for all kinds of reasons, it just sits wrong with a lot of people.
Pam: So what are your options if there is no health insurance?
Barry: Well, the options are relatively limited. One option that you would have would be to use what’s called medical payments or medical expense coverage that you would have through your own insurance or through the insurance of the car that you were in at the time of the accident. It’s no-fault coverage, but it’s a relatively low limit coverage. Typically it’s $5000 or less, which really doesn’t go very far after an accident happens, and there’s still that reimbursement obligation.
The other way to go ahead and get your medical bills is to have healthcare providers do what’s called putting a lien on the settlement, and essentially what that does is it gives them a right to get paid directly out of the settlement proceeds. The reason that you would prefer to use health insurance if it’s at all available is that that lien figure that you have to pay is going to be the gross amount that the doctor or the hospital or the physical therapy clinic actually bills out, and many times that’s a much higher figure than you would have to pay out otherwise.
So is there anything that people should be aware of in particular?
Barry: The one thing I tell all my clients to be aware of after an accident happens is the situation where you have a healthcare provider, whether it’s a doctor or a hospital, trying to tell you that we will “bill the liability insurance.” Where this happens is when you actually have health insurance, but you have the healthcare provider trying to put a lien on the settlement. Essentially what happens in that situation is instead of getting the benefit of the discounted amount that your health insurer has negotiated with the healthcare provider, they’re going to put a lien on the settlement so they can get paid the gross amount billed.