When handling an Injury Claim, Coordinating Health Benefits Can Be Critical


What are some of the pitfalls of representing yourself and not hiring an injury attorney after you have been injured in a car accident in Georgia? One of the major challenges is how to coordinate Georgia injury medical care benefits.Many people are hesitant to hire an injury attorney, worrying that they would have done better in their quest for just compensation without paying the lawyer one third of the recovery. It is a good analysis to go through. I have written extensively on the subject of when you need and attorney and when you don’t after a collision injury and you can see that article here. This entry will get into a real world example of the value a lawyer can bring.

One of major hidden reasons to hire an attorney after you are in a collision in Atlanta is that we have spent years maximizing the client’s actual in pocket recovery by coordinating health benefits. What does that mean? Let me explain with an example.

You have been in a car accident and you have broken your leg. You have $25,000.00 in gross medical bills, you have $5,000.00 in Georgia medical payments insurance on your Georgia automobile insurance policy and you have health insurance through United Healthcare. Let us assume that the at fault driver only has the Georgia minimum policy limits of $25,000.00 and you only have $25,000.00 in Georgia Underinsured motorist coverage, so there is no further coverage available for your loss. You find yourself lying in bed, looking at your leg and wishing that the teenager had not run the red light. What should you do now?

The answer to that question begins with another; how was the emergency room medical care paid for? Metro Atlanta hospitals are rapidly becoming experts at increasing their profits by refusing to bill health care insurers. They will typically ask the victim, “was this a car accident and who was at fault.” I believe that some hospitals do this because they are tired of having certain health care insurers deny the claim due to the fact that the injuries stem from an auto accident. Others , I fear, do it to go straight for the higher payout.
How does the hospital gain when they don’t bill your health insurance you ask? Think about the last time you received an explanation of benefits (EOB) form from your insurer and you saw that your doctor billed $150 for the visit but only got paid $80. That is because the health care insurer has a negotiated rate for each procedure. Think of it like a Sam’s club membership. Membership with an insurer reduces the price you pay for any care and it does not hurt the value of your injury case either. At trial I still get to put up the gross number, no matter what was actually paid. The hospital however wants to be paid the maximum amount and they will try to direct bill you and will take out a Georgia Medical Providers lien against your claim. They force you to claim against the driver that caused the collision.
What can you do about it? First of all the health insurer cannot refuse to pay the bills just because it was an auto accident. So long as you present your health insurance card or the policy information to the hospital, they are ultimately stuck with the negotiated rate unless….you have medical payments insurance. Med Pay is coverage on your auto policy that will pay your medical bills after a Georgia collision regardless of who is to blame. If you have Med Pay, your health insurance policy can rightfully take the position that it is a secondary payor. That means that it does not have to pay a bill unless you either lack Med Pay or the Med Pay has been exhausted.

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