One of the most common questions asked by a car accident victim is who will pay for my medical bills. This is not surprising since medical expenses are one of the biggest financial drains he or she will face. The answer is it’s complicated. Under California law, the person who caused the accident is responsible for the expenses the injured party experiences. This includes medical expenses as well as lost wages and property damage.
One complication is that the liable party or their insurance company may not pay until an investigation into the accident is completed or a lawsuit is filed. There are many different reasons why the insurance company will delay paying, but the outcome is the same – it puts an enormous degree of pressure on the victim.
Who Pays for Medical Care Immediately After an Accident?
Right after an accident happens, it is always a good idea to see a doctor. However, a claim has yet to be filed, and even if it were, it would take a while for it to be evaluated and perhaps negotiated or taken to court. However, despite worries about how the bills are to be paid, no one should refuse medical care after they’ve been involved in a collision.
If you are unable to get to a medical care facility on your own, then accepting an ambulance ride is also a good idea. In general, if you have insurance, your insurer will pick up the bills and be repaid later in a process called subrogation. That means that your insurance company will demand repayment from the responsible party’s insurance carrier.
Does It Matter What Type of Insurance I Have?
There are many options available to pay for medical care. These include private insurance, Medicare, Medi-Cal and that supplied by your employer. If you optioned for Med Pay as part of your insurance coverage or if the accident is covered through your homeowner’s policy, your medical expenses will be paid. Medical Payments Insurance (Med Pay) is an insurance rider that pays for your care regardless of who caused the accident. It also covers medical expenses for any passengers in your vehicle.
Payment of Medical Expenses for the Uninsured
Many people in the state lack any kind of medical insurance. Hospitals are required to arrange for a doable payment plan if the injured party is not insured or their income is not more than 350 percent of the poverty level federally. In some cases, a medical provider will be willing to take care of a patient and be paid through a medical lien.
In such situations, the provider will not expect payment until the case has been settled. Many lawyers are able to suggest doctors and other healthcare professionals who are willing to work on a lien basis. In other cases, a lawyer may be able to work with the hospital to structure a payment plan that is doable for a client.
Should an Injured Person Use Medical Liens to Pay for Medical Care?
There are two sides to a medical lien. First, it is not guaranteed that a case will be settled favorably for the plaintiff. Secondly, not everyone qualifies for a medical lien. Some of the factors that are considered are:
- Whether the person has health care insurance
- Cannot pay out-of-pocket for medical care
- Has trouble paying the deductible that might be demanded
Your lawyer will be able to assist you with finding medical professionals who are willing to work using a medical lien. However, if the case is decided in the defendant’s favor, you might be liable for paying part or all of your medical expenses. It is best to have your attorney draft the lien agreement since they may be able to structure one that is more favorable to the patient. Since the patient will be liable if the case is lost, the lawyer may be able to add a discount if this happens.
Health Insurance vs. Liens
The question always comes up about whether a lien is better than using one’s own health insurance. Since hospitals and doctors have contracts with the insurance providers, the amount of the bill is initially more favorable to the patient if the provider is in-network, and the injured person uses their health care insurance rather than a lien. The ACA or Affordable Health Care Act, under which many people are covered, does not have a lifetime maximum. The injured party will also have a broader range of providers to choose from if they use their own insurance.
What Happens If I Have Several Insurance Options to Choose From?
Some people have several insurance types that can be used to pay for medical care. Besides health insurance, they may have Med Pay, which is part of their auto insurance coverage or homeowner’s insurance to choose from. Let’s look at an example. Say that a person’s health insurance covers medical care but does not cover in-home nursing service. Under this circumstance, the medical bills will be paid for by the health insurer and the at-home nursing service may go to Med Pay. Your lawyer can help you decide where the bills should be directed.
Does the Health Insurer Get Reimbursed If the Case Is Won?
Yes. Under the process of subrogation, the negligent party’s insurance must pay your health insurer what they paid out. If you were required to pay your deductible when you received medical care, your lawyer can negotiate to have these out-of-pocket charges reimbursed also.
What About Med Pay?
Some people have insurance coverage called Med Pay. It is a special rider on your automobile insurance policy. Under this, all medical expenses are covered regardless of who was at fault. It is paid quickly, so you won’t have calls about unpaid bills to deal with. The payments are limited only by the coverage you choose when you picked out your insurance plan.
This type of payment has no deductible associated with it, so there is no haggling after the case is closed. You are covered even if you are in someone else’s vehicle as a passenger or if you are hit while out walking. It covers all types of practitioners, such as chiropractors and alternative health care providers. If someone is traveling in your vehicle with you when an accident occurs, their medical bills are covered too.
How Are the Bills Handled?
Your bills from everyone involved in your medical care must be submitted to the at-fault driver’s insurance company. Test results are usually also submitted along with the attending doctor’s diagnosis. Before paying out, the insurer for the defendant will also need medical records from anyone who cared for you medically. Your lawyer will be able to procure all medical records and send them to the appropriate parties.
You might also be asked to submit medical records for at least five years before the accident and from treating physicians who were involved in your care for a similar condition. Other medical records, as well as treatment for psychological conditions or drug abuse, are not necessary unless they reflect a condition involved in the lawsuit or claim.
What If I Suffered a Similar Injury Before the Accident?
Pre-existing conditions do not limit your ability to recover damages. On many occasions, the injured party will notice that an accident injury that was not symptomatic becomes so after the accident. This worsening of your condition can become a part of the lawsuit against the negligent party as long as you can prove that the accident likely exacerbated your prior physical injury.
