I Have Health Insurance. Why do I need a Personal Injury Attorney?
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I Have Health Insurance. Why do I need a Personal Injury Attorney?

by | Feb 24, 2016 | Blog |


You are injured in an automobile accident. You go to the emergency room, you follow up with your primary care physician, and you complete three months of physical therapy. You have health insurance that could pay your bills. Do you need an attorney?

The short answer: YES.

First and foremost, thankfully you have health insurance. If you didnt, you could be looking at significant outstanding medical bills. However, there are several issues with the use of health insurance that you need to be aware of.

Did the Hospital, Doctors, and Radiology Departments Actually Use My Health Insurance?

When someone is injured in an automobile accident and presents at the emergency room, the hospital will sometimes attempt to circumvent use of a patients private health insurance by having a client sign a separate agreement. The agreement states that the hospital can bill the automobile insurance for payment. In theory, this would make sense. You were not responsible for the accident and neither was your health insurance company. However, that agreement is not to your benefit. The hospital is really trying to access your medical payments coverage a separate coverage within your personal automobile insurance policy. Many times, that coverage pays 100% dollar for dollar to a hospital whereas health insurance pays somewhere between 40-60% under a contractual rate.

Medical payments coverage has many uses, but its best use is not for medical bills. Medical payments coverage is better used to cover health insurance deductibles, medications that fall outside of your insurance policy, and healthcare not covered in your network. An experienced attorney can help guide you on how to best utilize your medical payments coverage as well as control who and when it is accessed.

The Health Insurance Company Paid the Bills. Now They Want Paid Back.

If your health insurance company paid your medical bills, you may receive a notification that the health insurance company wants to be paid back from your personal injury settlement. This is called subrogation, and many people make the mistake of failing to resolve the outstanding subrogation lien prior to settling their personal injury case.

If you fail to pay back your health insurance company despite the company asserting a valid lien, you could face a lawsuit or loss of your health insurance. This is precisely the reason why you should consult an experienced personal injury attorney. A personal injury attorney can help resolve the subrogation as well as negotiate a resolution that benefits you.

Medicare or Medicaid (CareSource, Molina) Paid My Bills. Do I have to Pay it Back?

Government-backed health insurance must be paid back. Many insurance adjusters and attorneys call these liens a super lien. If it is a government-backed health plan, there are various penalties you, your attorney, and the insurance company can face by failing to pay back these liens. Again, it is imperative that you work with an experienced attorney that can help determine whether your government-backed health insurance should be used, how it should be used, when to settle your subrogation lien, and (as is sometimes necessary) whether you need a separate special account to help cover accident-related expenses.

Proper utilization of health insurance and medical payments coverage can help maximize the amount of money you receive from your personal injury settlement. However, it is important to talk to an attorney about how subrogation can affect your claim.

For a free consultation, contact Attorney Ashley Rutherford Starling.


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