The answer to the question of whether the other driver’s car insurance will pay your medical bills after an accident they cause, lies in the nature of the medical care, the timing and the character of the insurance company you are dealing with.
Part 1: Emergency Room Care:
When you have been involved in a serious car crash, paying for your emergency health care is probably not the first thing on your mind. This is understandable. Survival and recovery are the primary concerns, and the fact that emergency care is often rendered before any mention is made of payment pushes the issue even further from your mind. Unfortunately for those with health insurance, hospitals often take advantage of a trauma patient’s preoccupation with their injuries, and ignorance of the medical system, to burden them with significant bills that they should not have to pay.
The first thing to understand about hospital emergency room care is that they want your money, not your health insurance. The reason for this is simple. The “sticker price” for emergency room care is extremely high, but the amount hospitals are allowed to charge insurance companies is much more modest. Given a choice between charging full fair or taking a steep discount from a health insurance company, hospitals will choose the full fair every time. You may rightly ask how hospitals can expect to collect giant emergency room bills from injured individuals when people have insurance for just this purpose. They do it by subterfuge. Hospitals often tell their injured patients that they will simply bill “the at-fault driver’s insurance company.” That may seem like a good thing, but there are two problems with it. First, auto liability insurers never pay bills submitted directly to them from medical providers. What the hospital is actually saying is that it will assert a lien for the full price of its medical care on your recovery from the at-fault driver’s insurance company. This will require you to pay the hospital out of the settlement you receive from the other driver’s carrier.
Paying for your emergency room care from the settlement proceeds from the at-fault driver’s insurance company is the most costly option you can possible choose. A simple example will illustrate this point: A man is driving his car down Peachtree Street in Atlanta and is stopped at a traffic light when he is suddenly smashed into from behind by an inattentive motorist. The injured man is transported by ambulance to a local emergency room where his is examined, x-rayed, treated and finally released several hours later. While he is at the emergency room, a hospital office worker asks him for information about the at-fault driver’s auto insurance. The man offers to provide his own health insurance information but the hospital office worker says, “Don’t worry about that. We’ll just bill the other driver’s auto insurance company.” The “sticker” price of all of his emergency related medical care totals about $5,000.00. Eventually, the injured man receives a settlement offer from the at-fault driver’s auto insurance carrier in the amount of $10,000.00.
Based on the situation above, if the injured man attempts to settle his case for $10,000.00, he will have to pay the hospital $5,000.00 (because the hospital will have a lien against his settlement). Assuming no other expenses (such as attorney fees, for example), that will leave the man $5,000.00 for himself. However, if the man had insisted that the hospital bill his health insurance, the health insurance company would not have paid $5,000.00 for the hospital bill. It would have paid a greatly reduced “contract rate.” On an emergency room bill with a sticker price of $5,000.00, the health insurer may have to pay as little as $3,000.00. While the health insurer may also seek to be repaid from the $10,000.00 settlement, they will negotiate. Assuming that the health insurer will take $2,000.00 from the settlement, the man will take home $8,000.00 (instead of $5,000.00 by allowing the hospital to put a lien on his settlement). That represents a 37% increase in the money the man gets to keep after the settlement. Not a bad return for simply demanding that the hospital bill health insurance as it is required to do.
It is not enough to simply give the hospital your health insurance information and then hope for the best. Repeated follow up calls are often required to make sure that the bills are being sent to the health insurer for payment. This must be done relatively quickly. Some insurance companies (such as Kaiser Permanente) will not pay any bills submitted more than ninety days after the services have been rendered. Others (such as United Healthcare) may allow up to six months to submit the bills. Remember, too, that your ambulance bill must be paid. If you do not specifically call the ambulance company and give them your health insurance information, they will eventually turn your unpaid bill over to a collection agency. Do not let this happen.
Once you have succeeded in getting the hospital (and ambulance) to bill your health insurer, you still have work to do. Most health insurance includes “co-pays” and “deductibles” (those portions of the bill that the patient is responsible for). After your insurance has paid the majority of the hospital bill, you must call the hospital billing department and determine your remaining balance. Then, you must pay it. If you do not, the outstanding balances will eventually be sent to a collection agency which will adversely affect your good credit. Remember to determine your remaining balances from the emergency room, emergency room physician’s group, and the radiology group. These are three separate billers that will carry three separate balances.
Part 2: Longer Term Care:
After taking the steps necessary to pay your hospital emergency care related bills, you must determine the best way to pay for your longer term medical treatment. If you have health insurance, the best plan is to treat with the best doctors who will accept your health insurance. In the case of neck, back, or other bone related injuries, this is often an Orthopedic Surgeon. Always call the doctor’s office in advance to make sure they accept your particular health insurance plan.
For those unfortunate people without health insurance, the options for quality health care are far more limited. Chiropractors will often treat on a “lien basis” and will agree to be paid when your claim against an at-fault driver settles. There are also a number of “injury clinics” that have both medical doctors and chiropractors on staff that will treat on a lien basis if no health insurance is available. One such group in Georgia is The Injury Specialists with twenty one locations throughout Georgia. However, these clinics should not be used by people with health insurance. Higher quality care can generally be obtained at a lower cost to a patient with health insurance by treating with a traditional medical group or specialist.
Part 3: Health Insurance Reimbursement:
Once you have completed your medical care and are ready to settle your case, keep in mind that many health insurance providers will seek reimbursement from you from the proceeds of the settlement for the amount it paid for your medical treatment. Determining whether the health insurance plan is actually entitled to reimbursement is complex. Generally, self funded ERISA plans (governed by Federal law) are entitled to seek reimbursement. State plans not governed by ERISA may be entitled to seek reimbursement, depending upon the language in the policy, but must first establish that the injured person has been “made whole” by the settlement. When the time comes to reimburse the health insurance carrier, you will likely be dealing with a separate company hired by the health insurer to handle the transaction. Ingenix and Healthcare Recoveries are two such companies. Their job is to assist the health insurers in obtaining the maximum possible reimbursement. That said, these companies will negotiate. Never pay the full amount of the claimed reimbursement. Always demand a discount.
Using the proper strategies when paying for healthcare following an accident can make the difference between coming out ahead at the end of the process or finding yourself in debt. This is an easy aspect of your injury case to overlook. However, putting the time in to get it right will pay big dividends.