If you were injured in a collision and receive medical treatment for those injuries, then you also have medical bills. Sometimes medical providers and health insurance plans are legally entitled to money from your auto-injury claim. In this article, I briefly cover several situations in which you may need to pay a medical provider or health insurance plan money out of your auto injury claim or judgment.
- ERISA-Qualified Health Insurance Plan
You may have a private healthcare plan through your job or business—standard plans like BC/BS, Cigna, etc. If so, you probably used the plan pay all or part of the medical treatment from the collision. In some cases, but not all, the healthcare plan can require you to repay, from your claim, the money it paid for that treatment. The law on whether your plan can or cannot get the money back is determined by both federal regulations (ERISA) and Arizona law. If the plan is entitled to reimbursement, it can likely only collect from your claim against the other driver’s insurance, not against your own. For example, it cannot usually collect from an uninsured or underinsured motorist claim.
- Government-funded Healthcare Plan
If a government-funded plan, like Medicare or AHCCCS (Arizona), paid your bills, then that plan is usually entitled to get the money back from your personal injury claim. Unlike the ERISA plans, government-funded plans can usually even collect from uninsured and underinsured motorist claims.
- Balance Bill
If a traditional healthcare insurance plan paid the bills (think BC/BS), it is likely they did not pay the full charged amount, but rather some lower amount that the provider had agreed to accept from that plan for that service. If that happens, then the medical provider can file a county medical lien for the remaining difference between the plan’s payment and the full charge for the service. If the provider filed this lien properly, and can show that the full amount is “reasonable and customary,” then you may need to pay that remaining balance out of your settlement or judgment. These balance bill liens are usually collectible against the liability policy claim, but not uninsured and underinsured motorist claims.
- Traditional Medical Lien
Although each of the categories in this article is a “lien” on the claim, what I am calling a traditional medical lien arises when a medical provider and you have entered an agreement that the provider will simply wait for payment until your claim resolves, at which time you promise to pay the provider for the services. Obviously, if you have entered into such an agreement, you should likely pay the provider from the proceeds of your settlement or judgment.
- Otherwise Unpaid Bills
Let’s say you were taken to a hospital after a collision and they rendered emergency services to you, you had no health insurance (like BC/BS), no public insurance (like Medicare or AHCCCS), didn’t pay the bill, and the hospital didn’t enter an agreement with you to wait for payment. Well, you probably still owe the money and will need either to pay it from the proceeds of the case or otherwise do so. But, the law allows the medical provider to file a county medical lien under such circumstances, and put everyone on notice, including the auto insurance company, that they rendered services related to the claim and are entitled to payment. If the provider did this properly, then you should pay this lien from the proceeds of your settlement or judgment.
These are the most typical situations in which you may need to repay medical providers or healthcare plans from your personal injury settlement or judgment. To avoid paying the wrong people the wrong amounts, or missing payments to someone who should be paid, can be tricky, and another way a lawyer can give you both peace of mind and improve the financial result of your claim. If you have any other questions, please feel free to contact Attorney Kevin Fine with Davis Miles McGuire Gardner at (480) 733-6800 or via email kfine@davismiles.com.