As an attorney I see constant changes in the tactics used by hospitals and health insurers that are designed to put more money in the hospital and insurer’s pocket from the injured victims settlement and I have written about some of them previously. Today we will be talking specifically about two new situations my clients have experienced.
In the first one, my client treated at a major Atlanta hospital for a fractured sternum sustained in a car crash. He hired me as his injury lawyer six months after he received his medical care. He had $10,000.00 in Georgia medical payments insurance, he had Medicare and he had supplemental insurance. The hospital bills were over $45,000.00 gross. They billed the $10,000.00 to the med pay and took it all. Then they refused to bill the remainder to my client’s Medicare. They just chose not to submit it. Now, two years later, the hospital is trying to get the balance of the medical bills from the client and I told them to go to Hades. They are under contract with Medicare and cannot “opt out.” I told them to sue the client and when the complaint arrives, we will counterclaim for breach of contract and fraud.
The second new development I have seen recently comes from private Health Insurers. I have a client with a fractured wrist where her health insurance is refusing to pay after a Georgia car crash. She gave her health insurance information to the hospital immediately after the crash. The health insurer sent the client some paperwork to fill out requesting information on whether the at fault driver has med pay, and I have no problem with that. The problem is that the health insurer sent a “Reimbursement Contract” to the client insisting that the client has to sign a new contract promising to reimburse the health insurance program in full when the client makes a recovery for their injuries and without regard for Georgia’s “made whole” doctrine. This is ridiculous. First of all the contract fails for lack of consideration because the carrier is already obligated to pay the bills. I am constantly amazed by the insidious efforts by these Georgia Health insurance companies weasel their way around the Georgia legislature. I recently sent back a letter outlining these points to the insurer and am eagerly awaiting their reply.
I find that generally speaking, smaller hospitals have billing departments that are more efficient and they often understand that some clients are only going to be able to recover the $25,000.00 minimum limits in Georgia. As a car accident lawyer with offices in Gainesville, Georgia, I find that the local hospitals in Conyers and Gainesville will often “get it” early on and open an emergency medicaid application for the client when they can. At least the hospital gets some renumeration and we then pay medicaid back at their lower contract rate, resulting in a win for all involved.