Medical Bills

What Are Medical Bills?

Medical bills of an injured party are covered by California law if a wrongdoer causes an accident or injury. The liable party's insurer may pay these bills directly or by the company or person responsible. However, responsible parties do not always pay their bills on time. A delay can sometimes be intentional in order to make a low-ball out-of-court settlement more attractive. The injured party may end up filing a lawsuit as a result.

In order for an injured person to get his or her medical bills paid after a California accident or injury, he or she may need to inquire about: Private health insurance; Government health insurance, such as Medicare or Medi-Cal; California "Med Pay" auto insurance; or a provider who will work with a "medical lien".

Medical Bills Paid For

A party who breaches a duty of care in California is legally responsible for the injured party's medical bills and other damages. However, the party who breaches the duty of care seldom admits responsibility or pays the bills right away. Medical bills can be paid while people wait for a case to go to trial or to settle.

There are several types of health insurance available - such as those obtained through an employer or Covered California - or government coverage such as Medicare and Medi-Cal. California homeowners' and renters' policies, as well as California Medicare-supplemental insurance for vehicles, are also options.

Injured and No Health Insurance

According to California law, hospitals must negotiate discounts and a reasonable payment plan with patients: Who are uninsured, or whose family income is not more than 350% of federal poverty level. In California, there may be providers who are willing to work for a "medical lien".

Providers who work on a lien basis will delay payment until your case is resolved.

Using Personal Health Insurance

After an accident in California, it is generally preferable to use health insurance rather than a lien-based medical provider. In the event of a lawsuit or out-of-court settlement, medical providers that provide services on a lien basis get reimbursed. Bills that exceed any eventual recovery, however, are the responsibility of the patient.

Additionally, when working on a lien, providers typically charge their full rate. Nevertheless, the provider cannot legally charge you more than the contract rate if you use your insurance. Particularly if you have a preferred provider in your network, this can be considerably more advantageous.

In addition to these benefits, private insurance provides a number of other advantages, among them prohibiting lifetime maximums and yearly caps on payments, and usually providing injured people with a wider selection of providers.

For the reasons stated above, we recommend seeking health insurance instead of paying a doctor on a lien unless: you do not have health insurance (either privately or through the government); you desire a provider or service not covered by your insurance (for instance, chiropractic care is not covered by your insurance); or you are unable to afford a deductible and/or co-pay.

Using My Insurer’s Discounted Rate

Lawyers and insurers for the other party will not penalize someone for their health insurance discount. Regardless of how much a patient or insurance company actually pays, settlements are based on the full value of a doctor's bills.

More Than One Insurance Policy

There may be situations in which you wish to submit first to one type of insurance rather than another if you have good insurance coverage in California. If you have multiple policies, there may be more than one policy that will cover your medical expenses. If your health insurance doesn't cover chiropractic care and you want both an orthopedist and a chiropractor. If this is the case, orthopedic bills may go to your health insurer, while the chiropractic bills may go to your Medi-Cal plan (discussed below).

If you choose to pick and choose, an injury lawyer can help you make sense of it. As a general rule, however, you should send your bills to ALL insurance companies that might reimburse you.

Paying Health Insurance Back

Insurers, both private and public, usually have a right called a "subrogation right." This means they are entitled to reimbursement from any lawsuits or out-of-court settlements. You are eligible for this claim only if you are actually compensated by the wrongful party.

A claim can be made on your behalf by your insurance company in some cases.

Despite the fact that this may seem convenient, the insurer's goals are likely to be different than yours. Nonetheless, you may still want to hire an attorney to look out for your interests, not just those of your insurer.

Using California Med Pay

Medical payments coverage, also known as "Med Pay" in California, is available as an optional auto insurance policy. In order to get medical insurance, you must elect it and pay a separate premium for it. Medical payments coverage is provided regardless of fault by your auto insurer up to the amount you select - usually $1,000, $2,000, $5,000 or $10,000 per person.

It is necessary to consider Med Pay for a variety of reasons, including: No deductible on medical payments; The insurer must pay even if you are at fault; Covers practitioners (e.g., chiropractors and acupuncturists) who might not be covered by your health insurance; Applies even when you are a pedestrian or a passenger in someone else's vehicle; Payments cannot be applied to reimburse your health insurer.

In general, you should use Med Pay if you have it, and let both your auto and health insurer determine who pays what.

Submitting Medical Bills

Your bills will be needed by the other party's insurer. Additionally, your doctor or primary care provider will need to provide a diagnosis and test results, such as x-rays or MRIs.

Notes should be kept by your doctor or therapist with information about the treatment you received after your accident or injury. Furthermore, the other insurer is likely to request relevant medical records dating back at least five years.

In California, for instance, if you are claiming a neck injury, you will have to provide five years of records from your primary care doctor, chiropractor, orthopedic doctor, and any other provider who treated you for similar injuries. Records from unrelated doctors (such as those from colorectal surgeons or gynecologists) are not necessary unless your injuries affect those areas. Unless you are claiming damages for anxiety, insomnia, emotional distress, pain and suffering or other, non-physical injuries, you do not need to provide records of substance abuse, psychological counseling and similar services.

Information that will speed up the payment of medical bills includes (but is not limited to): The names and contact information of all parties and witnesses; Reports from your insurance company and any police accident reports; Photos of your injuries (if visible); Videos of the accident scene, vehicles, defective products, etc.; or any other information that might be helpful, such as statements of witnesses, co-workers, friends, or family members.

Pre-Existing Injuries

Pre-existing injuries make recovering damages from an accident difficult (though not impossible). In the event that your pre-existing injury was aggravated by the accident, you are still entitled to receive compensation.

Settlement Short of Paying Bills

It is possible that the other party's insurer will not offer you a settlement big enough to cover your expenses. It may be tempting for you to take the offer because it is better than nothing.

Your California personal injury lawyer can help you determine the strength of your case and the value of your bargaining position. If you have a good attorney, they can negotiate a higher settlement and/or reduce your medical providers' bills. Ultimately, it's not the total settlement amount that matters, but how much of it you get to keep. To pay for your medical bills and compensate you for your pain and suffering, I want to let you keep as much of your settlement as possible.