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Is Your Health Insurance Paying for Your Injury Accident?

Published May 10, 2018 by Bruce Millar

Accidents can be scary, especially when injuries are involved, no matter how severe. After you are involved in an accident, it is the obvious choice to seek medical attention right away for any injuries that you suffered in the accident. However, once you have been to the hospital, the medical bills, including visits with doctors, lab work, x-rays, etc., will begin to quickly add up, which can be very overwhelming, and the healthcare providers will search for the payments wherever they can find them. Having the knowledge of who is responsible to pay, and how to file such claims with insurance, can relieve great headaches down the road.

In addition, if it is known that the injuries were caused by a car accident, some healthcare providers will attempt to avoid sending the bills to your health insurance provider in an attempt to get paid more. Large health insurance carriers have negotiated reduced rates with many treatment providers. Such treatment providers would prefer to be paid directly from an auto insurance carrier (or directly from you!) following the accident so they can avoid taking the reduction.

Subtitle: Reporting Medical Expenses to Insurance Companies

Upon seeking medical treatment, you should provide the hospital or doctor with all the necessary information to bill your health insurance carrier directly. The usual deductibles and co-payments (co-pays) will be your responsibility, so we recommend that you pay those right away.  Please note, however, that some auto insurance policies have medical payment coverage called “med-pay.” This coverage will pay medical bills, including deductibles and co-pays, up to a certain amount, regardless of who was at fault.  When you bring a claim or case against the insurance company of the at-fault driver this is what is known as a third-party claim.

While speaking to your health insurance company directly, you should inform the case manager of all treatment received in response to the injuries, both past and ongoing. This allows the insurance company to request billing statements directly from the health care providers to determine all balances that may be owed.

Subtitle: Who Pays the Full Medical Expense?

Regardless of whether you have insurance or not, the medical costs are first and foremost your responsibility. While this seems harsh, the logic is simple. You and you alone were the recipient of the treatment. Therefore, if the bills are not getting paid promptly, the health care provider will be looking directly to you.

There is a chance that your personal health insurance company could reject the medical expenses from your injury. This possibility, however, depends on several factors including whether or not the health care provider that treated your injuries accepts your health insurance. Furthermore, as a general rule, medical insurance providers will pay for injuries only if no other insurance will cover the loss. Additionally, many health insurance policies require that your auto coverage pays out first, before your health insurance will provide any coverage.

Unless your health insurance policy directly states that it does not cover injuries caused by accidents, it should assist with the costs, no matter who was at fault. If you do not have auto insurance, and you are the only injured party, it is likely that your health insurance will cover the costs. If another party was involved in the accident, though, the health insurance carrier will wait to see if the other party is at fault and their insurance will cover your injuries.

Because most health insurance companies will not move forward with a claim until all other claims have been denied, it can take quite a long time to receive coverage for the medical expenses. Most medical providers, though, are familiar with this process and will be patient with you.

If you do not have the money to cover the medical expenses prior to your getting reaching a resolution, it is best if you make payment arrangements for the bills that you receive. Alternatively, attorneys may pay the medical bills out of any recovery received on your behalf.

Subtitle: Negligent Injury Expenses

Insurance companies have what is known as subrogation or a claim to be reimbursed from the money you recover from a successful car accident claim or case.  If the injured claimant was not at fault during the accident, the insurance company may assert a lien against the funds, you, the injury victim recover from the at-fault party to absorb all or some of the medical expenses. Such medical liens are usually negotiable, and in some cases can be avoided entirely – but don’t expect the health insurance company to tell you this!

Subtitle: Ask the experts.

Medical claims are complex, and the more insurance companies involved, the more complicated the matter becomes. If you are involved in such a situation, it would be in your best interest to speak with an experienced personal injury attorney.

Our lawyers advocate tirelessly for our clients, fighting for them to get the results they deserve and money for the injuries and damages inflicted during an accident. Together, we have over 75 years of experience, giving us the knowledge and expertise to effectively and efficiently resolve your claims. Contact our Atlanta or South-Atlanta law offices for a free consultation today.

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