Getting involved in a motor vehicle crash might leave you with injuries and medical bills. If you have read any of my prior posts, you know what to do in the event of a crash, and that you should submit your medical bills to your health insurance. Your health plan is there to cover medical bills, right?
Then the dreaded happens. What do you do if your health insurance says “no?”
Can they do that? The short answer: yes, most likely. But all hope is not lost so long as you’ve taken the steps to ensure you are fully covered. More on that in a second.
First, why would a health plan deny coverage for your injuries? And what options do you have if this happens to you?
Unbeknownst to most of us, your health insurance policy undoubtedly contains a clause designed to limit what the health plan has to pay for. The clause in question allows the carrier to reject bills if they were incurred due to the fault of a third party.
A third party like a car crash that is someone else’s fault.
If you head to the hospital for your injuries, you will probably be questioned about the cause of your injuries. Many hospitals immediately ask if you were involved in an accident and, if so, whether there is anyone else responsible for that. You see where this is going?
If you say yes, they may “refuse” to bill your health insurer because of the third party clause. Even if they do submit the bill to your health plan, your carrier may still reject those bills because of the third party fault.
No one wants to be in a place where you have to foot a large medical bill simply because someone else caused your injury. To keep from landing in that position, I always counsel people to maintain significant auto insurance coverage that includes a hefty limit for medical payments or personal injury protection (also known as PIP).
When you have medical or PIP coverage with your auto insurance, you aren’t left with a giant bill if your health insurer won’t pay for a third party crash. Simply submit the medical bills to your auto carrier.
The devil is in the details here. If you have one emergency room visit, you may be looking at a $2,000 bill. This would easily be paid if your auto insurance has a $5,000 med pay limit.
But what if you are hospitalized for a serious injury that requires extensive treatment? Multiple ER visits? Surgery? Unless you have a significant amount of med pay coverage ($25,000? $50,000?), you will not have a way to pay your bills until your case resolves with the third party’s insurance.
Additionally, I always suggest that you be as vague as possible at the emergency room – not so much that you put your care at risk or lie. But the hospital doesn’t need to know every little detail in order to help you.
I also suggest submitting bills directly to your health insurer YOURSELF. Let them catch the fault in the accident. If they don’t, you may get your bills covered at a steep discount. If there is any co-pay or out of pocket deductible, again, you can submit that to your auto carrier yourself for coverage.
Another bonus is that when you settle your injury case, you will have to pay back (subrogation) your health insurer. By submitting the claim yourself, you will have less to pay due to your carrier’s discounted rate. If you pay back the auto carrier (which your policy most likely also requires) and you have a lawyer, they will typically reduce this amount commensurate with the percentage of attorney fee your lawyer takes on your case.
As in all cases involving injury and potential liability, if you have been in an accident, report the crash to police and your own insurance company, and contact a lawyer with expertise in your type of case, such as motor vehicle accidents.
If you've been in an accident and have questions, contact Chicago personal injury attorney Stephen L. Hoffman for a free consultation at (773) 944-9737. Stephen has nearly 30 years of legal experience and has collected millions of dollars for his clients. He is listed as a SuperLawyer, has a 10.0 rating on Avvo, and is BBB A+ accredited. He is also an Executive Level Member of the Lincoln Square Ravenswood Chamber of Commerce.
Stephen handles personal injury claims on a contingency fee basis, which means you don’t pay anything upfront, and he only gets paid if you do. Don’t wait another day, contact Stephen now.