Warning! This is a boring topic but it is important to know. As an attorney who regularly represents victims in automobile accidents (please continue reading) this is a scenario I see far too often. Hence, I am sounding the alarm to those of you who have stayed with me so far. For those that continue you cannot say “nobody ever told me that”.
There you are having a fantastic day. You are just driving along to your next destination. Suddenly and without warning someone runs a stop sign and T bones into you! They may have been too busy figuring out what emoji to send in a text that they were not paying attention. Or they could have been drunk or simply absent minded. For whatever reason, you are now in serious pain and in urgent need of medical attention.
The ambulance arrives and whisks you to the ER. While there you produce your health insurance card. You are sent in for x -rays and other tests and eventually released. You give no thought about the bill as your hard-earned money has been spent paying health insurance premiums to protect you in such a scenario. All of that will be taken care of. Right? Well, maybe not. It depends.
Some hospitals will promptly file your bill on your health insurance. However, others will not and they will never tell you that they are not going to. Why? Note that when you go into a medical facility for treatment that one of the first questions on the form you fill out asks if the injury was accident related. Here is the deal. Large health insurance plans negotiate for discounted rates from medical providers. The medical providers give these discounts due to the high volume of potential patients they may obtain from those insured by the big health insurance companies. However, part of a personal injury settlement in an auto accident case involves paying off the medical providers when a case is settled as well as paying back the health insurance company for the benefits they paid.
Knowing this, some hospitals will stay silent and wait until the case is resolved and demand full sticker price for the medical services instead of the discounted rate they would receive from their patient’s health insurance company. In some cases, they will even file a hospital lien of record in court! But if the hospital has an agreement with the health insurance company, they must accept payment from that plan. They just do not have to file it. The difference in the sticker price for medical services vs. the price one has to repay their health insurance company for those services can be huge.
On top of everything else an automobile accident victim has to deal with one needs to make sure that their bills have been filed on their health insurance. One can take a bill from the hospital and file it with their health insurance carrier themselves and it will be paid provided that not too much time has elapsed from the date of treatment. If filed too late, the hospital is still owed money for the services. Deadlines vary depending on the insurance plan. Those who have optional med pay insurance on their auto policy can also file on it depending on what their limits are but must do so promptly.
In my view, ethics and fair dealing should require a hospital to tell a patient that they are not going to file their bills on their health insurance. But many do not. As they say “there ought to be a law”.
