If you have been injured in an automobile accident caused by another driver, you rightly expect that the other driver or his insurance company will be responsible for your medical bills. Because of that fact, it would be easy to conclude that your healthcare plan should not have to pay the bills for your treatment, and you may be inclined to tell your medical providers to send the bills to the auto insurance company rather than bill your health insurance. Unfortunately, that logical assumption is usually the wrong way to handle your medical bills. You are often better off having your health insurance plan pay what it will toward your bills, even if you have a claim against an auto insurance policy.
You should make sure that your medical providers bill your health insurance plan, rather than relying upon payment at the end of your case, for a number of reasons. First, your healthcare plan may not have the right to collect the money back that it paid toward those bills, so you get to keep that money. Second, even if you have to pay back your healthcare plan, it has very likely paid a lower amount for your medical services that what you were billed, so you have less to pay back. Third, even if the healthcare plan has reimbursement rights, it will usually accept less than it paid out for your bills. And, finally, if your case falls apart and you cannot collect, your medical bills have already been paid!
Some medical providers are quick to volunteer to wait for payment, instead of using your healthcare plan. Some just think they are being helpful. Others recognize that, because of the lower rate usually paid by healthcare plans, they will be paid more by waiting. They may not recognize that this gain for them causes a loss to you, for the reasons above.
Sometimes there are parts of the treatment that the healthcare plan doesn’t pay—certain services, co-pays and deductibles, or the full amount of the bill for a certain service. For these balances, it may be appropriate to ask the medical provider to wait until you have a settlement or judgment, from which to pay those amounts. If the provider agrees, this is referred to as a medical “lien.” Such liens are best applied to amounts left after a healthcare plan has done what it will.
As always, this information is general, and does not take into consideration the specific circumstances of an individual claim, so it is not legal advice. If you feel you need counsel more specific to your circumstances, you can reach me at 480-733-6800, e-mail me at firstname.lastname@example.org, or find me our web site www.davismiles.com.