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I got a call today from a very frustrated caller. She was injured after another car ran a red light and t-boned her vehicle. Unfortunately, she fell into the same trap many fall into after an auto accident - she assumed the insurance company would "take care of everything." After all, that's what the adjuster told her over the phone.
She didn't have health insurance so she contacted the responsible party's insurance company to ask for help with her medical care. A few days later, she got a letter from the insurance company that stated she could go to "any doctor or health care provider of her choosing." She was also told to present her bills to the insurance company after she concluded her treatment. They said they would "be there for her." She didn't consult with a lawyer, so she simply assumed she could go get whatever medical care she wanted, and they'd kindly pay for it. Big mistake! Just because an insurance company says you can choose any health care provider you want doesn't mean they are going to pay for that health care. Their letter was technically correct. She could indeed go to "any provider" she wanted. I asked her, "Does the letter say they will pay for all your bills - no questions asked?" Of course, they didn't say that. So she went and incurred nearly $10,000 of medical care on a soft tissue case (sprains and strains). Now she owes $10,000 to various doctors, and the insurance company for the responsible party has offered her a whopping $500 for her case. They said her medical treatment was excessive and unwarranted. This of course was no shock to me, but she couldn't believe it. Truth be told, her bills were probably far too high, but that's not the lesson here. Here is the lesson: Don't get medical treatment and simply assume the other party's insurance company is going to pay for it. Insurance adjusters rarely accept the medical bills you send them at face value. Remember, their job is to "adjust" your bills (that's why they're called insurance ADJUSTERS.) Here's the big surprise - they ALWAYS adjust your bills downward! Expect them to slash your bills by at least 33% to 50% (sometimes more). So don't go racking up $10,000 in bills and assume they will pay. In fact, you should assume the opposite - assume they WON'T pay. Keep your bills low and reasonable. When in doubt, find other ways to pay for your care so you're not stuck with a stack of bills while fighting with an unreasonable insurance adjuster. If you have health insurance, consider using it. If you have medical payments coverage under your own auto policy, consider using that too. You need to be mindful of your bills. Keep track and periodically ask your health care providers how much your bills are. Don't let the bills get out of control. There is nothing rude or wrong in asking about your bills. Your health care is not an "all you can eat" buffet. It's a good idea to contact a personal injury lawyer and run your questions by them. Don't assume the insurance company is going to pay your bills. You may dig yourself into a financial hole. Talk to an experienced attorney about your options. Feel free to call us at (661) 414-7100 to see if we can help you. VIDEO TRANSCRIPT:
Hi, this is Robert Mansour. I'm a personal injury lawyer, and today I want to spend a minute cautioning you not to get yourself into a financial hole if you've been involved in a car accident. Let's say you've been involved in a car accident and you're injured. Do not assume that because the other party's at fault that they're going to pay for everything. So don't go accruing bills everywhere, going to different doctors, CT scans, x-rays, massage therapists, physical therapy, renting a car for three or four weeks. Don't just go nuts thinking that the other party is going to pay for it all. The truth of the matter is you don't know whether they're going to pay for it or not. Even if the responsible party tells you at the scene of the accdent, "Hey, it was all my fault, I'm really sorry" ... Just because that individual said that doesn't mean their insurance company is going to agree with that assessment. Reasonable minds may differ. So all of a sudden, you might find yourself with all kinds of medical bills and you have no way to pay them because the other party has rescinded their position, changed their position, or they simply won't accept fault for the accident, and now here you are, holding all of these bills in your hand with no way to pay them. Be very careful how you approach this when it comes to personal injury accidents. Find out all of the different resources that are available to you and which path might be the most prudent. If you have a case similar to this where you need that kind of assistance or guidance, please feel free to call my office. Thank you very much for watching this brief video. You might think your personal injury medical bills are $50,000 or more. However, you might be surprised when the insurance company offers you $23,000 for your case.
You see, when it comes to presenting your damages in a personal injury case, it's not what you are billed that matters. It's what your health care provider accepted as payment in full. Therefore, even if a doctor bills you $1500 but accepts $250 from your health insurance company, all you get to present in your case is the $250 he or she accepted as payment in full. Even if your doctor doesn't accept your insurance, you don't get to present whatever number you want and assume the insurance company is just going to accept what you send them. So if you send the $1500 bill to the adjuster, they might reject it. Remember, the insurance adjuster's job is to "adjust" your bill, so they will argue your doctor's bill is not "reasonable." In fact, if your doctor bills you $1500 but routinely accepts $250 for the same care provided, you might have a potential problem on your hands. The insurance company may argue his reasonable fee is actually $250 since he routinely accepts that amount for similar treatment. Several important California court decisions have come down the pike in recent years. Each case continues to reinforce the basic fundamental issue that all plaintiffs must now accept - your bills are not what you think they are. You have to find out what your health care providers accepted as payment in full and that is what the adjuster will consider. So if your hospital bill was $4000 but Medicare paid $900, then you're stuck asking for the $900. In many cases, you may find your "big" personal injury case isn't as "big" as you once thought. To complicate matters, your health insurance providers (including Medicare, Medi-Cal, etc) may insist on their right to reimbursement. As such, more and more plaintiffs are finding that presenting a personal injury claim is much more difficult than they thought it would be. Medical bills are known as "economic" damages. More insurance companies are slashing these economic damages since medical providers are accepting a fraction of their bills as payment in full in most cases. Therefore, it is becoming increasingly important to focus on your "general damages," often known as "pain and suffering" damages. These damages are not about bills - they are about HOW an accident affected your life. You must document how the accident affects your daily life activities, school activities, work etc. "General damages" are becoming more and more important as economic bills are being slashed and reduced. Don't lose sight of your general damages. Make sure your attorney and doctors are well aware of HOW the accident has affected your life. Make sure these issues are documented in your medical records. As I always warn my clients - If something isn't in your medical records, it's like it never happened! Today I wanted to write a blog entry about medical bills that you might incur during your personal injury case. If you incurred medical bills from the hospital, an emergency room, urgent care, or other facility, you are responsible for those bills. Don't ignore them.
Yes, theoretically, the responsible party should be paying for those bills. However, what you need to understand is that the responsible party is NOT going to pay for these bills as they are incurred. You can't just mail them to the responsible party and expect them to pay. For example, if you go to the hospital, you will get a bill from the hospital. They don't provide free medical care. They don't care that somebody else is responsible or if you were in the hospital because of someone else's negligence. All they want to do is get paid. The same goes for the emergency room, the ER physicians, the ambulance, and anybody else who assisted you with your injuries. They just want to get paid. Therefore, you need to find a way to pay them. First, you can pay out of your own pocket. Second, you can submit your bills to your health insurance company or have the healthcare providers bill your health insurance directly. In many cases, you may also be able to get your bills paid by your automobile insurance if you have medical payments coverage on your policy. You will also probably owe a balance even after those resources have been used. That balance is your responsibility, and you must pay it. If you can't pay the entire amount, try to arrange for a payment plan. Just call the provider and work something out or they might send you to collections. Remember, even though the other party is indeed legally "responsible" for those bills, you need to pay them to keep yourself out of collections and to make sure you don't get into any financial trouble. Ultimately, your attorney will present all of those bills as part of your settlement demand. Also, just because you incur bills doesn't mean the responsible party is going to agree to all of them. One of the biggest mistakes I see is when clients get accident-related health care bills in the mail and simply ignore them. Sometimes they don't even open the envelope. They mistakenly assume they are not responsible for those bills and simply send them to my office or ignore them altogether. If you get bills or collections notices in the mail, you need to forward those to your attorney. Your attorney is not automatically getting copies of the collection notices or any of your bills for that matter. That being said, giving your bills or collection notices to your lawyer doesn't mean you don't have to pay them. Your lawyer needs to be aware of your bills, but that won't absolve you from responsibility. Remember, the health care providers don't care who was responsible. They provided a service, and they want to be compensated. Is it fair? Is this how things should work? Probably not. However it is the way the personal injury world works, and we have to work within those realities. So here is the lesson: Make sure your bills get paid and are not ignored. Find resources to pay them whenever possible. You lawyer can help you figure this out. Ultimately, the lawyer will include all of those bills as part of your settlement demand of the defendant. If you need help with your personal injury case or have any questions, please feel free to contact our office at (661) 414-7100. VIDEO TRANSCRIPT: Hello everybody this is Robert Mansour and I wanted to make a brief video today about the issue of medical payments coverage. Medical payments coverage is something that a lot of people have under their insurance policy, and they're not even aware of it. Your auto insurance policy may have some coverage for you called medically payments coverage, or MPC. And what that means is they basically serve as a health insurance company for you.
So, let's say you don't have health insurance. If you have medical payments coverage under your auto insurance policy, they might be able to pay for your health care coverage, or your health care needs after an auto accident. Now, it's important to know what the limits are of your medically payments coverage. So, for example you, might have $2,000 available to you or $50,000 available to you. You need to make sure, number one, that you have it available. And number two you have to know what the limits are. In some cases, I've seen client with $25,000 of medical payments coverage available to them, and the nice thing about this is you can get your health care providers paid quickly. Some of the health care providers don't understand personal injury cases and they don't want to work on a lien, for example. They don't want to defer their payment or late on in the case, they want to get paid now. And, if you don't have health care insurance, it might be good to use your medical payments coverage. In some cases, it might be good to use your medical payments coverage. In some cases the medical payments coverage will only pay after you've exhausted your health care coverage. So, if you use your health care coverage first, and then you have some money left over that you have to get paid, some bills, you can use your medical payments coverage at that point. The other thing is they may want you to exhaust your health insurance coverage first, your health care coverage options, or at least demonstrate that you don't have health care before the medical payments coverage kicks in. In many cases, and I would say in most cases, the insurance company has the right to reimburse them of their medical payments. So, let's say that you recover money from the party at fault. You probably have to repay your insurance company for the medical company they advanced on your behalf. So, it's, not necessarily a freebie. So, let's say that the insurance companies pays $5,000 to the doctors on your behalf under your medical payments coverage. If you recover money from the other party – let’s say you recover $10,000 - you have to repay your insurance company for the medical payments coverage that they extended for you. Now, that is in most cases a contractual obligation that many clients aren't even aware of. So, make sure you talk to your lawyer about your medical payments coverage, whether or not it's even going to be available for you, and also make sure you discuss the right of reimbursement that most insurance companies have when it comes to the medical payments coverage provision. If you don't have medical payments coverage, talk to your insurance professional and see if it would be appropriate for you. In most cases, it's not very expensive and it can be very helpful if you have a personal injury case. Thank you very much for watching this video, I hope you found it helpful. Call (661) 414-7100 for help with your personal injury matter. Many times, I ask my clients for copies of the medical bills they incurred after an accident. Immediately after a car accident, some people go to the doctor, hospital, etc and start incurring medical bills. These are some of the bills I need to help properly represent my clients. Some doctors will provide this information directly to me, especially if they've handled personal injury matters in the past.
The answer I almost always get is, "Oh, I got that from my health insurance company. They sent me the bills in the mail." Well, my clients are usually wrong about this. What they actually got is an "Explanation of Benefits" form (also known as an EOB Statement). This form is from their insurance company. It generally shows what they were billed, any discounts applied to the bill, what the health care insurance actually paid (if anything), and any amount the client is expected to pay. It looks like a bill of some sort, but it's not a bill. It's an "explanation" of benefits. You see, the EOB statement is NOT your bill. The actual bill is a recitation of all the services etc. you received from a particular health care provider and how much they charged you for the services. It's similar to shopping at the store - they give you a receipt that shows all the things you bought and how much you were charged. That's what I need. What you get from the health care insurance company is a document generated internally by the health insurance company - not the actual bill from the health care provider. Your co-pay and EOB information is important but it's not the actual bill. How do you get the actual bills? You call the health care provider and say, "Hey, send me my bills." They will either mail/fax them to you or you can pick them up. You are entitled to that information. Make sure to forward all bills to your attorney. Realize that many health care providers do not do their own billing. Their billing is often handled by a third party company, often off the premises, and sometimes not even in California. Either way, you are entitled to your own bills. I also like to get copies of my clients' EOB statements as well to show clearly what was billed and what was paid. That information is also important, but please don't confuse your EOB statements for your actual health care billing. They are not the same thing. If you don't have health insurance, check your car insurance policy for "Medical Payments Coverage" (MPC) which might pay for your medical bills after an auto accident. If you don't have MPC, you should call your insurance company and ask about it. It's very inexpensive and very good to have on your auto policy. Even if you have health insurance, they may not pay for everything in which case MPC is a terrific bonus to have! You can't always rely on the responsible party to pay your bills after an accident.
However, keep in mind that if you recover any money from the responsible party's insurance carrier, you may have to reimburse your own insurance company for payments made pursuant to your Medical Payments Coverage. They usually have a right to reimbursement. While this may be the case, there are times when you can negotiate the amount owed, and in some cases, your insurer might agree to a total waiver. You can’t just settle your personal injury case without making sure all the doctors and other service providers have been paid. Any doctor or medical service provider is not usually providing their service out of the goodness of their heart. They expect to get paid. In some cases, the health care professional is working on a lien, expecting to get paid out of any settlement you might receive. In other cases, the health care professional may have been paid by your health insurance company but they have a balance that must be paid because they were not a “preferred” provider. This is known as “balance billing.”
Other times, the doctor has already been paid by your health insurance, but what most folks don’t realize is their health insurance provider expects to be reimbursed from any settlement proceeds. They could technically come after you for reimbursement in many cases. That is an unpleasant surprise if you’ve already spent the proceeds or settled for less than you should have. Also, if your own insurance company paid any of your medical bills, they might also be expecting reimbursement. If you have Medi-Cal or MediCare, you can bet they want their money back from your settlement! You should always make sure all involved parties have been addressed. Many people are surprised to learn that the insurance company for the party at fault does not pay their medical bills as they become due. In other words, they won’t pay your medical bills until you are finished with your treatment in most cases. This can prove to be an unpleasant surprise for many people. Also, the treating doctors aren’t terribly happy about it because they want to get paid.
Keep in mind the insurance company for the party at fault doesn’t really have any obligation to you. First, they have to “investigate” and “determine” whether or not the accident was your fault or not. After that, don’t expect them to pay your medical bills whenever you present them. First, they will have to “determine” whether or not your treatment was reasonable in THEIR opinion. In some cases, they use databases or other computer software to make that determination. Then, they will look at every single charge you incurred to see whether or not they agree with the charge by the doctor. If they don’t agree, they will slash the doctor’s bills – in many cases dramatically, leaving you with a big hole to fill. So all the assurances of the world from the other party’s insurance company should mean nothing to you at the end of the day because there is no guarantee they’re going to pay your medical bills. In most cases, the adjuster alone determines your charges are unreasonable. Yes, this is the same adjuster without a medical degree. As a personal injury lawyer in the Santa Clarita, CA area, one of the things I always have to make sure I do as a lawyer is clear any and all liens that might be attached to a person’s injury case. Therefore, before I make a demand from the other party’s insurance carrier, I have to make sure all those parties and entities that might have a lien are resolved. Here are some things to consider:
1. Did my client’s car insurance company pay any money for the medical treatment? Many of my clients have something called “Medical Payments Coverage” under their own insurance policy. In some cases, this “MPC” coverage pays for the medical bills. If so, I have to make sure that we address their reimbursement. Sometimes, they are willing to waive reimbursement under the right circumstances. 2. Did any of my client’s medical providers work on a “lien” basis? If so, they need to be paid for their services. If the doctors work on a lien, that means they provided care with the anticipation they will be paid from a potential settlement. 3. Did my client’s health insurance company pay for any care? If so, most health care companies have the right to reimbursement. Therefore, those issues need to be addressed as well. Before making a demand for settlement and/or actually settling my client’s cases, I have to address all existing and potential liens on the case. Otherwise, my clients might be facing an unpleasant surprise later. |
Attorney Robert MansourRobert Mansour is an attorney in Santa Clarita, California who has been practicing law since 1993. After working for 13 years for the insurance companies, he now counsels victims of personal injury. Click here to learn more about Robert Mansour. Categories
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