One of the most common questions after a Virginia car, truck, or motorcycle accident is – who should be paying my hospital, emergency room, doctor, and medical bills?
Although it may seem counterintuitive, the answer is your health insurance. All bills from hospitals, doctors, and other medical providers after an accident should be submitted for payment directly to your health insurance by the medical provider.
This may not seem right to you at first glance. After all, your life has been turned upside down because of the careless and reckless actions of another person, and that person should make things right. Part of making things right, in your eyes, is paying for the medical care to treat the injuries they caused. So why, you ask, should your health insurance be paying?
First, medical providers need to be paid now or you will not get the treatment you need. While the other driver’s auto insurance will ultimately pay for your medical bills once the case is settled, settlement may take months or even more than a year. You need treatment now and doctors need to be paid now, or you will not receive the treatment you need to recover.
Second, using your health insurance to pay medical providers, quite simply, will result in more money in your pocket down the road. Even if your health insurance plan is the type that requires reimbursement from any settlement or judgment, using your health insurance will still result in more money in your pocket later. The reason is that health insurers do not pay the full cost of a bill that you would pay if paying out of pocket– rather they have an “adjusted rate” or “negotiated rate” that is something less than the full cost. In other words, part of the bill is written off by the medical providers as part of their agreement with your health insurance company. If you are required to reimburse your health insurance from the settlement, you are only required to reimburse them for the lesser rate that they pay.
Here are few examples to illustrate how this can work in your favor.
Scenario #1 - $1,000 medical bill when health insurance is not billed
- $1,000 (recovered from other driver’s auto insurance) - $1,000 (balance owed to the medical provider) = $0.00 net recovery to you.
Scenario #2 – $1,000 medical bill when non-reimbursable health insurance is billed
- $1,000 (recovered from other driver’s auto insurance) -$100 (co-pay owed to medical provider after health insurance payment and write-off) = $900 net recovery to you.
Scenario #3 - $1,000 medical bill when reimbursable health insurance is billed
- $1,000 (recovered from other driver’s auto insurance) - $100 (co-pay owed to medical provider after health insurance payment and write-off) - $300 (reimbursement of negotiated rate payment health insurance made to medical provider on your behalf) = $600 net recovery to you.
So, if when you were seen at the hospital or doctor’s office, you wrote something along the lines of “bill auto insurance” and provided the contact information the officer gave you for the other driver’s auto insurance, this needs to be fixed as soon as possible.
Fortunately, there is a handy law in Virginia, 8.01-27.5, that says once you notify the medical provider, they must bill your health insurance if you are in-network, provided they are notified within the timely billing period. This statute does not apply to Medicaid, Medicare, or Tricare, but you should still direct medical providers to utilize your coverage under these plans.
We can help you with these issues. Contact us today for a free case evaluation.
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To speak with a personal injury lawyer about your case and how to recover compensation in Fairfax County and Northern Virginia, contact Manikas Law LLC by calling 703-556-0004, or use the “Contact Us” box at the bottom of this page to tell us about your case.