This topic applies to any type of personal injury or a third-party claim. Essentially any injury except Workers Compensation, which has an additional layer of complexity that I won’t be addressing in this post. So, this applies to anyone that is involved in a car accident, a slip and fall, a trip and fall, an animal or dog attack, bike accident etc.
In paying your medical bills, there are generally 5 categories of how your medical bills can be paid.
1) Medical Payment Coverage
The first place to look is your own auto insurance policy if a car was involved in the accident. This includes if you are a pedestrian hit by a car or a bicyclist hit by a car, and of course if it was a car vs. car accident. On your own insurance policy, you may be paying insurance premiums for years that entitle you to what is called Medical Payment Coverage, often referred to as Med-Pay (insurance sold in states outside of CA often call it Personal Injury Protection or PIP). If you have Med-Pay, its often not a huge amount of money but it can help. The typical amounts range from $1,000 to $5,000, but if you carry a lot of health insurance you may have much more. Med-Pay is no fault coverage you are entitled to and which should be promptly paid to you upon the presentation of the medical bill and medical record. Now after the Med-Pay has been paid out and your 3rd party case (the case against the defendant) is settled, your own insurance company will be entitled to a partial reimbursement for what was paid out. The real benefit of Med-Pay is to provide cash to cover medical bills so that you do not need to dip into your own savings or take on debt while waiting for a settlement.
2) Private Health Insurance
There are many types of private health insurance, but largely its PPO vs. HMO. A PPO plan will provide you with a variety of “in-network” medical providers and “out of network” providers that you can pick and choose who you see. However, some of these providers may be reluctant to treat you if they know you are involved in an accident (if this is the case, contact Haling Law for help). An HMO plan has a much more limited array of physicians you can see, and you often require referrals. Either way, your private health insurance should, but not always does, provide coverage to pay your medical bills caused by being in an accident. However, your private health insurance company will send you or your attorney a “lien” for any amount they pay for your medical care related to the accident. People rarely read their health insurance contract but hidden in there is a provision entitling your health insurance company to repayment out of a personal injury settlement. If you ignore the health insurance company’s claim for reimbursement, they may refuse to provide insurance coverage on future medical bills. Haling Law is experienced and knowledgeable in handling private health insurance companies and negotiating their claims for reimbursement.
3) Public or Government Health Insurance
This is if you have Medicare, Medi-Cal, La Healthy, SF Healthy, county health plan, or even the VA. For any government provided health plan, you have a legal obligation to report the case to the government agency so that the agency can make a claim of reimbursement when the case settles. Failure to report the case to the appropriate government agency can result in significant penalties and is not advisable. Typically, your health providers that treat you under these health plans are not ideal medical providers for your injury case. Government health plans are legally “secondary insurance” and are options for treatment when there is no “primary insurance.” In an accident case, the liability insurance policy is legally considered “primary insurance” meaning it’s the defendant’s insurance that is responsible for the medical bills. The problem is the defendant’s insurance will not pay-as-you-go when the medical bills arise. The best option when you have a Public or Government Health Insurance is use it as a last resort, but seeking medical care on a “lien” basis makes more sense and fits the role government health plans are suppose to play much better (because again, government health plans are not primary but secondary sources of health coverage). To put it another way, why should taxpayers pay your medical bills when the defendant has a viable insurance policy and caused your injuries?
A lien is essentially a legal promise that you make to a medical provider that gives the medical provider legal rights to money from your settlement. This is done so that you do not have to pay up front for medical care, instead the medical provider receives a promise their bill will be paid when the case is over. Most medical providers will not enter into a lien agreement with a patient unless the patient has an attorney who will also be a signatory on the lien because the medical provider will then have the assurance that if the lien is not pay, the provider can report the attorney for an ethical violation in not honoring the lien agreement. Liens are an incredibly valuable tool made available to you when you hire Haling Law because it will provide you with access to the very best medical providers that many people could otherwise not afford.
5) 3rd party Companies advancing payment
The last option to cover is private financial companies that will advance payment of medical bills to provide you with medical care. Essentially these companies “buy” the medical bill for prescribed treatment and pay the provider directly. The financial company then has a “lien” on the case for reimbursement, typically for an amount higher than they paid the medical provider. This is usually only an option in major surgery cases where a surgery can cost over $100k. A doctor does not want to take the risk of doing a $100k+ surgery on just a promise of payment and will want some payment of their bill. These financial companies should be treated as a last resort of payment to cover significant medical bills and Haling Law is experienced in dealing with them.