You have a serious injury from a collision, it was clearly the other driver’s fault, and the at-fault driver was in a commercial truck, so there is likely a decent insurance policy.

injury claimBut, you need surgery and have no health care plan to cover the procedure. You know that the liability insurance on the truck that hit you will eventually pay the medical bills for your treatment, but they have told you they will not pay them ahead of time–only as part of the full and final settlement. And, no surgeon seems willing to do the surgery and wait for payment until the end of the case when you settle (called a “lien”).

How do you get the surgery you need now, so you can later submit the cost of it, as well as the other consequences, as part of your injury claim? Because this is not an uncommon problem, a few businesses have stepped up to fill this gap. They give themselves various labels, but I will call them medical service facilitators. These facilitators have contacted medical specialists that perform services that are often needed by accident victims, but that most doctors (particularly surgeons) demand healthcare plans or up-front payment to perform. The facilitators actually pay the doctor directly and then the facilitator, not the doctor, waits for payment (“lien”) until the settlement or judgment on the claim. Of course, the facilitator is taking a risk that the case may not be successful, and they also need to make a profit, so there is a gap between what the facilitator charges and what they pay the doctor. My experience has shown me that the charges for the service, because of the middleman markup, end up being at the high end of the market range, but at least the claimant can get the needed treatment.

A client of mine had his own small business, which made enough income to support his family, but barely. He did not have a healthcare plan. The serious auto accident he was in blew out his knee–he needed a full knee replacement. And, as usual, the opposing insurance company would not agree to pay for it in advance. A medical service facilitator found a surgeon who accepted payment from them, he performed the knee replacement, and the facilitator waited for payment out of the judgment almost a year later. In that case, without the facilitator, my client may have had to get a judgment in court first, and hope a jury would include an amount for a future surgery. Meanwhile, he would been living with an unusable and painful knee the whole time (Loans in personal injury cases are another option, and a topic for a different article).

A “catch’ in using these services is that many of them will not work with claimants who do not have an attorney. They are already taking some risk, and feel that risk is mitigated when an attorney is pursuing the claim. But, there is no legal restriction to their helping an unrepresented person. So, although the price for the procedure may be higher than a healthcare plan normally pays, the medical facilitators fulfill a vital function when there is no healthcare plan and no up-front cash to pay for needed medical services.

Of course, I am talking about Arizona law, and this general information may not be right for your specific claim and is not legal advice. I’d be happy to talk to you, so give me a call at Davis Miles McGuire Gardner, 480-733-6800, or reach me at kfine@davismiles.com. You can also get my book, Arizona Auto Injury Claims, at www.autoinjurybook.com.