Don’t Lean On Bills Being Paid

Health insurance claim form application for medicare coverage and medical treatment for patient with illness, accident injury and admitted in hospital ward

Most people assume that when they are involved in a car crash or slip and fall personal injury case, their medical bills will be paid by the other party at fault.

Actually, that’s not at all how it works. Our system is terribly unfair to injured parties. Let’s explore how it is unfair, why the system is what it is, and what you do about it.

Systemic Inequality

Hospitals, physicians, therapists, and other health care providers can place a lien upon a personal injury case, hoping to get paid in full out of the settlement funds. Many refuse to directly bill a patient’s health insurance carrier. They would rather be paid 100% of their bill later on, or, a good chunk now by way of the person’s auto insurance medical payments coverage, than to receive a negotiated, contractually reduced rate from the health insurance (which prevents them from “balance billing” the patient).

In other words, you can be injured in a car crash, brought to the hospital via ambulance, undergo tests, surgery, and then rehab, only to find out there are huge liens against any recovery in your personal injury case, and that NONE of the bills have been paid.

Sometimes, the providers will tell you they cannot bill your health insurance because it is someone else’s fault (not true!).

An additional issue is that your health insurer may claim that it is not responsible for paying a bill because it is incurred due to the fault of a third party. This may be true—many health insurance policies provide for just that.

To make matters even more confusing, plaintiffs’ attorneys are limited in how much they can reduce the amount of liens on cases. Through a byzantine system of percentages, only if specific categories of liens (hospital vs. health care provider, as an example) exceed a certain percentage of the overall settlement, can they be reduced, and then, only to a specified percentage of the settlement. In contrast, most health insurance and auto insurance medical payments contracts do allow reductions of as much as one-third. So the injured person gets hit twice—injured with bills unpaid AND less money in their pocket.

How Did We Get Here?

The health insurance industry is a behemoth. So is the healthcare industry. There is a ton of money involved and, not surprisingly, a lot of that money is spent lobbying legislators and pushing for laws that help the industry save money.

If you are a lobbyist representing a group of hospitals, you certainly would prefer to collect $10,000 in the future by placing a lien on the file than you would be to collect maybe $2,000 now under the health insurance negotiated rate.

When you read news items about “greedy plaintiff’s lawyers,” “runaway verdicts,” or “tort reform,” understand you are reading messaging meant to taint one side of the equation while allowing the health care providers and insurance companies to massage legislation that favors their interests.

Just to give you one example, one client recently received liens totaling nearly $50,000 of unpaid medical bills from a recent auto crash. Despite having health insurance, robust auto insurance medical payments limits, and advising each provider to bill her health insurance, no provider did, offering the excuses highlighted above. Fortunately, with my guidance, these bills are being obtained and submitted to the client’s health insurer, and we hope to see them paid shortly.

What Can You Do to Make Things Lien Your Way?

Sorry for the obvious pun, but it’s what I do. Dad jokes for lawyers.

First things first. Whenever you see a medical provider after an accident, please insist that they bill your health insurer. Do not accept their nonsense about “having to bill the other party’s auto insurance.”

Then, follow up. Obtain the bills from your providers. Use a medical authorization to do this. You are the patient and you have a right to your bills!

Next, submit them yourself to your health insurer. Keep copies. Submit them in writing. Follow up to make sure they are paid.

If you have significant medical payments coverage limits on your auto insurance policy, submit any unpaid bills or copays to that insurer.

Retain a lawyer. We lawyers can “add value” to your case not just in obtaining a larger overall award, but in knowing how to reduce liens, submit bills for payment, and guide you through the process.

Finally, read your insurance policies, both health and auto. Make sure you understand any limitations, how claims should be made, and any applicable time limits.

Following these suggestions will allow you to take charge of your bills and get things leaning in your favor.

Contact Chicago Personal Injury Lawyer Stephen Hoffman

As in all cases involving injury and potential liability, if you have been hit by a vehicle, immediately get medical treatment, report the crash to police and your own insurance company, and contact a lawyer with expertise in your type of case, such as bicycle accidents or pedestrians hit by cars.

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 over 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 up front, and he only gets paid if you do. Don’t wait another day; contact Stephen now.

Categories: Personal Injury