Personal Injury – Medical Bills Dilemma

After you’re involved in a personal injury accident; whether it be a motor vehicle accident, slip and fall, dog bite, or other similar action, you will seek medical attention. Very often, this will result in an ambulance ride to an emergency room, a family or friend driving you to the emergency room, or perhaps, you or someone else driving you to an urgent health clinic. Either way, there will be costs associated with the medical transportation and/or medical treatment.

Immediately after an accident, you may have exchanged insurance information with the at-fault party. Your first instinct may be that the at-fault party’s insurance should have to pay for your medical bills, and you are not wrong; but, there are specific ways to go about recovering against an insurance company. If you take the at-fault party’s insurance information, such as the name of the insurance company and policy number, and provide it to the emergency room triage nurse or front desk staff as the insurance coverage on your treatment, most likely, those expenses will not be paid (at least not at that time, or how you are expecting them to be paid). Similarly, if you file a claim with the at-fault driver’s insurance and then simply provide the insurance company and claim number to your doctor, hospital, therapist, etc., most likely those expenses will also not get paid (again, at least not at that time, or how you are expecting them to be paid).

A “third-party” case, or a case against another driver, a homeowner, or property owner for a personal injury case is unlike a claim under workers’ compensation. In workers’ compensation, you provide the insurance claim number to a medical provider and the billing and payment go directly from the medical provider to the insurance company for payment. If your workers’ compensation claim is accepted, most likely the expense will be paid, and you will not be contacted or informed about the means and process for payment. However, that is not how personal injury cases are handled for payment of medical expenses. In fact, providing the at-fault party’s insurance company, policy number, and or claim number (unless it is the claim number for the “medical payments” portion of the insurance coverage) can actually cause more problems than benefits in your case. This is especially true if you have a regular health insurance plan, Medicaid, or Medicare. Issues can arise with using the at-fault party’s insurance as your “bill-to” insurance, because if and when payment is not issued, the facility will contact you for payment of the amount in full. This can cause delays in payment, issues with potential collections if the delay goes on for too long, and in worst-case scenarios, a delay of too long may cause the bill to be unable to be submitted to your health insurance company.

In a personal injury case, when you go to the emergency room, a hospital, your doctor’s office, a physical therapy facility, radiology office, or for any medical treatment, use your health insurance card for means of payment, if possible. If not, the best alternative is the use of “medical payments” coverage, either through the at-fault party’s insurance, or through your own insurance. A separate claim may need to be open with the medical payments department of the insurance company, and using a claim number given to you when you reported the accident will often not be sufficient for payment.

The reason simply giving the insurance information to a medical provider will not ensure payment, is because the at-fault party’s insurance company does not engage in a “pay-as-you-go” practice. Instead, how a resolution of these types of cases works is once medical treatment is completed, or once a significant and certain amount of medical expenses has been incurred, a demand for settlement or for a turnover (tender) of the entire amount of the insurance policy is placed upon the insurance company. After a settlement or tender of the insurance policy is completed, a portion of the compensation received is used to pay off medical expenses, co-pays, insurance liens, physician’s liens, and/or other lien holders.

As such, when you are in a car accident, slip and fall accident, or other personal injury accident, you should give your medical providers your primary health insurance, Medicaid, or Medicare information. You should still file a claim with the at-fault party’s insurance and secure a claim number. However, afterward, give that information to your attorney representing you in the matter. If you do not seek counsel, which we would not recommend, retain that insurance information until after you complete treatment. If there are co-pays, co-insurance, or deductibles with your health care plan, you may need to pay those expenses up front, and then keep records of all payments made for a later potential recovery in your resolution of the claim. As discussed above, you may also be able to use “medical payments” coverage for co-pays, co-insurance, or deductibles, so save copies of payments made and again, give that information to your attorney. Once your medical treatment is completed you and your counsel will fight to try and get all your out-of-pocket expenses, your medical expenses, your lost wages, and your pain and suffering compensated by the at-fault insurance company.

Simply put, while the at-fault person should be held accountable, and their insurance company should pay, there is a specific means by which to attempt to secure payment of compensation. Due to these concerns, we always recommend you seek counsel to represent you in a personal injury matter. If you believe you may have a case, please contact the injury attorneys at Urban & Burt, Ltd. for a free consultation (708) 687-5284.