If you incur hospital bills after a car accident, you might be wondering, "Who is responsible for paying for my hospital bills?" The short answer is - You! Just because someone causes you harm doesn't mean they are going to pay for your hospital bills. The hospital, emergency room, doctors, xrays facilities, etc. expect to be paid. You can't simply ignore those bills. I've known some clients who get hospital bills and toss them in the trash thinking, "These aren't my responsibility. I don't need to worry about these bills." The truth is you DO have to worry about these bills. When I tell clients they are responsible for their hospital bills, many protest, "Why should I have to pay these? I'm not the one who caused the accident!"
So then I tell the clients a little story that oftens help explain the situation: Let's say someone vandalizes your home one day by painting graffiti all over it. You catch them in the act and call the police. The police show up and arrest the perpetrators. So far so good. Then you hire Johnny's Painting Company to come and remove the graffiti and repaint your home. Johnny and his crew do a great job. Then Johnny knocks on your door and asks you to pay him for the work. You can't tell him, "Listen, I'm not going to pay your bill. You need to go after the people who vandalized my home." Johnny isn't going to do that. It's not his problem. He provided a service and expects to be paid. Paying him is your responsibility. Then you can theoretically pursue reimbursement from the vandals. So basically, it's the same story with medical care - the health care providers will provide a service to you, but you need to pay them. You can't expect them to go after the responsible party for payment. There are some medical providers who will provide you service on a "lien" basis. Those providers are not the subject of this posting. When a provider is on a "lien," that simply means you are promising to pay them for their service at the conclusion of your case. You are basically deferring payment to them. This FAQ deals with providers who are NOT on a lien (most hospitals, ER doctors, urgent care centers, PPO doctors, etc.). Since you have to pay the hospital and related bills, you need to determine what resources you will use to pay. First, if you don't have health insurance, you can ask the providers to treat you as a "cash" patient. Generally, most providers have a "cash" price that is often a fraction of what they would charge to an insurance company. Some also have special programs available to people who need financial assistance. Most will accept payment plans as well. Second, if you have health insurance, you can simply use that to pay. However, if you have a high deductible, that might be burdensome. Most health care providers who are "in network" will charge you the negotiated rate they have with your health insurance company. That is often far less than "sticker price" on most services. Keep in mind if you recover money from the responsible party, most health insurers have "reimbursement" provisions built into their contracts. That means you need to reimburse your health care insurance company if you recover money from the responsible party. In general, you only need to reimburse them if you recover. You are not obligated to recover money for them. Third, you might have coverage for health care expenses under your own automobile insurance policy. Many folks have "medical payments" coverage under their own policy and they don't even know it. Many insurance companies aren't eager to tell you about this, but you need to find out if you have it. In many cases, you can have your bills (copays, etc.) paid by your own car insurance company. You've been paying for this benefit so you might as well use it. As with the health insurance companies, your auto insurance company also has a right to reimbursement if you recover compensation from the responsible party. Make sure you don't ignore these reimbursement provisions. In most cases, your auto insurance company will send you a letter reminding you of this obligation if they pay any funds pursuant to any medical payments coverage. The main thing you need to keep in mind is that you are responsible for paying your health care bills. You can ultimately recover them from the responsible party, but that doesn't absolve you from the responsibility of paying your bills. Therefore, you can't just ignore or throw those bills in the trash when you get them. Talk to an experienced lawyer about how you might handle your accident related medical bills. There are several approaches you might consider, each with its own pros and cons. If you are involved in a serious car accident and need advice, feel free to contact our office at (661) 414-7100 to see if we can help. VIDEO TRANSCRIPT:
Hello, everybody. My name is Robert Mansour. I'm a personal injury lawyer and I wanted to make a brief video today about liens and personal injury cases. You see, after you have your personal injury case and you settle your case, you're offered a certain amount of money from the insurance company. What you have to realize is that from that settlement amount, you have to pay the doctor's fees in some cases, outstanding medical bills. There may be liens on the file. For example, there's an attorney's fee. You may have to repay your health insurance company. They may have a lien. A workers' compensation insurance company may have a lien, Medicare...Medi-cal. In other words, you have to understand that the settlement amount is one thing, but then you have to pay all of these entities and then there is the residual amount that goes to the client. Let's say for example, I have a case that's settled for $20,000, and the client nets let's say $10,000. The clients in some cases get very frustrated and I understand why because they say, "Well, wait a minute. All I got was $10,000," and I say, "Wait a minute. You got $20,000, but you see, you had to pay a whole bunch of different service providers and then you got $10,000." The client say, "Well, that doesn't seem fair," but actually, that's how it works. You see, there's two components to these cases. There's the economic damages and the non-economic damages. The non-economic damages are sometimes called pain and suffering. Let's say you have $10,000 in bills and you wen to a jury, and you went to a trial and a jury came back and the jury said, "Okay. We're going to give you $10,000 for your bills." By the way, assuming they buy all of your bills. "Then we're going to give you say $10,000 in pain and suffering." That's your result, $20,000. You still have all these bills that have to be paid. You see, that's part of your recovery. In a personal injury case, your focus should not be on what you net but should be on the entire amount of the settlement. That is the value of the case and you will net less because different providers need to get paid. Of course, a good lawyer should explain these things to his or her client and make it very clear that this is how the process works. I hope you found this video helpful regarding liens and payments and personal injury cases. Thank you very much for watching. After an accident, doctors and health care providers that provide treatment for you will be expecting a pay check. You certainly don't want your medical bills being sent to collections and damaging your credit. So here are a few options you should consider to prevent this from happening.
Consider sending your bills to your health insurance company. They will most likely charge you the lowest rate by the health care providers. In most cases, they probably have a "negotiated" rate with the provider. However, the insurance company for the responsible party will use this lower amount (that was accepted as payment in full) in an effort to minimize your accident. In other words, if you were charged $2500 by a hospital, the hospital might accept $500 as payment in full. The insurance company will use this lowered amount of $500 and try to paint your accident as "minor". After all, $500 in damage sounds less dramatic than $2500 in damage. So while your bills are indeed paid, they will use the lowered amount against you. If you do not submit your bills to the health care insurance company, you typically end up paying what’s called the “list price” for health care. As we know, hospitals and doctors can charge outrageous prices, so you don't necessarily want to get stuck with those figures. Make sure you discuss your options for payment with an experienced lawyer. In some cases, going through your own health insurance company is a good idea. In other cases, it may not be the best route to take. There are other options in many cases. If you had an accident, call our office at (661) 414-7100 for a free consultation. We can also tell you about the pros and cons of billing your health insurance company versus pursuing other payment options. If you were injured in an accident, you may be concerned about medical bills that will start piling up. I've had some clients tell me they declined an ambulance ride because they knew they couldn't afford it. Even if you have medical insurance, there are scenarios when your co-pays and other incidental expenses can really burden you and your family. I've known some clients who've had to declare bankruptcy as the result of mounting health care bills.
There are circumstances when you can indeed get medical care from certain doctors who are willing to work on a "lien" basis. That means the doctors will defer their payment. You have to pay them out of your personal injury settlement. However, you need to be careful that your bills don't get too high or they might exceed the true value of your case. If you have $10,000 in medical bills but your case is likely worth $5000, then you might have a problem. Also, technically speaking, you are still on the hook for the bills even if you don't recover anything from the other party. The doctors aren't working for free. Therefore, before obtaining medical care on a lien, make sure you are likely to obtain a recovery that will be sufficient to pay your bills. An experienced personal injury lawyer can guide you. Also, if your personal auto policy had Medical Payments Coverage, that might also help pay for a portion of your medical bills. It would certainly be worth exploring this additional payment option. When you have a car accident and make a claim, you just can't call the insurance company and say, "Hey, can you guys send me a check for $10,000?" First thing they will say is, "What the heck for?" When it comes to these cases, you need to have "evidence." Your word that you were hurt and deserve compensation will get you a cup of coffee at most. You need to provide documentary evidence. That means you need to get your medical records together along with any bills you incurred. Keep in mind, getting the bills means exactly that....not the EOB statements you get from your insurance company. What your health insurance paid is important, but you should still get your hands on the bills the health care providers actually generated. Sometimes, the billing is generated by another separate third party facility. Short story is that you can get your own records and bills relatively easily by asking for them. The health care providers are obligated to give them to you. After all, they are YOUR medical records and YOUR medical bills. Now you have the "evidence" you need. Now get ready for "argument!"
Well, yes and no. You may be surprised to learn the other party’s insurance company usually won’t pay your bills as they come due. Your health care providers won’t be too excited about that. Keep in mind, the other party’s insurance company doesn’t have a contract with you. Frankly, they don’t even have to return your calls in a timely manner – if at all! Even if they do eventually pay, don’t be surprised to learn they won’t pay for all your bills.
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. |
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November 2023
by Robert MansourRobert Mansour is a personal injury lawyer serving Santa Clarita, Valencia, |