Many people who are involved in auto accidents wonder how their health insurance may come into play if they need treatment, or, if they used their health insurance to pay for treatment relating to an auto accident what will happen to their medical bills. This blog entry will also discuss other avenues available under your auto insurance policy to recoup expenses paid toward medical bills relating to an auto accident. The purpose of this blog entry is to explain some of the basics relating to health insurance and auto accidents and the current state of affairs as they stand in Louisiana today.
AUTO INSURANCE – MEDICAL PAYMENTS COVERAGE
Before we start talking about health insurance, I would first like to discuss medical payments coverage in your auto insurance policy. Medical payments coverage in your auto insurance policy pays for medical expenses related to an auto accident even if you were at fault for the accident. In many cases, people are not aware of this important coverage benefit which they have been paying for because auto insurance companies do not bring this benefit to the insured’s attention. However, medical payments coverage is not included in every auto insurance policy. To determine whether you have medical payments coverage, you need to review the declarations page of your auto insurance policy.
To obtain a copy of the declarations page of your auto insurance policy, you can contact the agent who sold you the policy, or most insurance companies now have online portals which will allow you to download your declarations page from your member account on their website. I am insured by Safeco Insurance Company and I have an online member account. To obtain my declarations page, I login to my online account and select the option to “download policy documents.”
Once you have a copy of the declarations page, you will be able to determine whether you have medical payments coverage. Do not rely on your agent or insurance adjuster’s verbal representations, always get a written copy of the declarations page to confirm for yourself. I have inserted a copy of my declarations page below, to show you how to find out whether you have medical payments included in your policy. Most auto insurance declaration pages follow the same format, so yours should be similar no matter what auto insurance company you have.
From the declaration page, look for the medical payments coverage and then look to see the limits of that coverage. The limits are different from the premiums. The premiums are the price you pay each year for the limits of coverage. Here, you can see I pay $35.70 per year for $5,000.00 in medical payments coverage. If I am involved in an accident regardless of whether it is my fault or not, and I incur medical expenses, I can contact my auto insurance company who will reimburse me for my medical expenses up to $5,000.00.
The moral of the story is that, health insurance is not the only benefit which may be available to you to cover your medical expenses if you are in an auto accident. If you have medical payments coverage on your auto insurance policy and you are considering hiring an attorney to represent you, you should ask that attorney whether they charge an attorneys’ fee to recover your medical payments coverage. Most attorneys do charge a fee to recover medical payments coverage, however, at the Cardone Law Firm, we do not believe in charging our clients to recover their medical payments coverage. Thus, whatever we can recover for you under the medical payments coverage of your auto insurance policy, goes directly to you and we do not charge an attorneys’ fee for this amount recovered.
Whether your attorney charges to recover medical payments coverage is an important consideration. This is so because you could be left facing outstanding medical expenses after attorney’s fees. Attorneys’s fees increase depending on whether your case goes to litigation. For example, I have made the table below to show what would happen if I had $4,500.00 in medical expenses and I hired a regular attorney who charged an attorney’s fee for recovering the $4,500 from my medical payments coverage:
In any situation, where any attorney charges an attorney’s fee to recover your medical payments coverage, you are still going to owe a balance on your medical bills. That is why it is always imperative to ask your attorney whether they charge a fee on medical payments coverage. Thus, the question for your injury attorney is not: What is your attorney’s fee? Instead, the question you should be asking is: What insurance coverages do you charge an attorney’s fee on?
Finally, you should realize medical payments coverage on your auto policy applies even if you do not have health insurance. With the rising cost of health insurance, even though every person is mandated to carry health insurance, we occasionally have people who come to us who do not have health insurance but who do have auto insurance with medical payments coverage. Even if you don’t have health insurance, you are still going to be charged by the health care provider for any medical care you received. Therefore, if you have medical bills from an auto accident and you do not have health insurance, you can still recover from the medical payments portion of your auto insurance policy.
HEALTH INSURANCE AND AUTO ACCIDENTS
Using your health insurance to pay for treatment relating to an auto accident can be tricky and you can run into some traps along the way. We always discuss our client’s health insurance, and sometimes we may opt not to use our client’s health insurance and this can actually work in our client’s favor. Below, I will take you through some of the considerations and the analysis process with go through with our clients to determine how to get our clients fully compensated for medical expenses relating to an auto accident.
HEALTH INSURANCE AND LIABILITY FOR THE AUTO ACCIDENT: WHEN YOU ARE AT FAULT
The first point of analysis is: Who is at fault for the auto accident? If you caused an auto accident due to your own negligence and you need to receive medical treatment, you should and can use your own personal health insurance to pay for the medical treatment. After all, that is why you have health insurance. Each individual should consult their own health insurance plan to see what services are covered and what co-pays may be owed as this varies from plan to plan. Most individuals can download their insurance plans online. I am insured by Blue Cross/Blue Shield of Louisiana and I am able to access the policy language of my health insurance plan online through their member account login page.
When you are at fault for an auto accident, remember what we discussed earlier? Medical payments. The medical payments coverage in your auto insurance policy can be used to pay for your medical expenses not covered by your health insurance plan. If you receive medical payments from your auto insurance company, your health insurance company may try to re-coup the payments they made back from you from the money your auto insurance company paid to you. Whether this is possible depends on the language in both your health insurance plan and your auto insurance plan. In Louisiana, the collateral source rule should prohibit such recovery but the language of the two insurance policies will prevail and dictate the ultimate outcome. Generally speaking, your health insurer should not be able to recoup the medical payments made to you when you are at fault for the auto accident.
HEALTH INSURANCE AND LIABILITY FOR THE AUTO ACCIDENT: WHEN YOU ARE NOT AT FAULT
When you are not at fault for an auto accident and incur medical expenses relating to your injuries that you charge to your personal health insurance, a number of things can happen and potentially go wrong. Lately, one main problem we have been seeing are situations where a client does not consult us and attempts to handle their injury case on their own using their own health insurance. The main problem that arises with this is the lack of linking causation by doctors who fear their medical bills will not be paid. I will explain further below and it should be noted each health insurance company and doctor is different, this is simply a generalized overview based on our years of personal injury experience at the Cardone Law Firm.
When you go to a doctor, use your health insurance and advise them your complaints are related to an auto accident, many of these doctors will not put this fact in their narrative medical reports because they will get push back from your health insurance company who initially does not like to pay the bill. This is why many doctors forms will ask if you have hired an attorney or whether the accident is related to an auto accident. This is so doctors can protect themselves if the health insurance company tries to refuse to pay the medical bill the doctor submits on your behalf.
Most people think a doctor would never intentionally leave something out of their medical report, that is simply not true. I have personally seen examples of numerous circumstances where this happened. Thus when a client uses their health insurance to pay for a doctor visit related to an auto accident, the client should always make clear on the physician forms that the injuries are due to an auto accident. Otherwise, trying to convince the responsible party the treatment was actually related to the auto accident will prove difficult. That is why most attorneys will fund your medical care in Louisiana and avoid your health insurance to avoid problems with causation and information doctors may intentionally omit simply to ensure their bills are paid.
If you want to consult an attorney and you have already used your health insurance for treatment related to an auto accident, you can certainly do so and the attorney may be able to help you negotiate a lower price for your medical expenses if your health insurance carrier is seeking reimbursement for the medical expenses they have paid as a result of the auto accident. If your health insurance carrier makes payments for medical expenses incurred by an accident that was not your fault, they may seek reimbursement from you. This usually starts by the health insurance company sending you a letter and asking whether the treatment was related to an auto accident. If this occurs, I always encourage individuals to seek specific advice from an attorney.
If your health insurer has paid your medical expenses incurred due to an auto accident that was not your fault, whether they are entitled to get their money back from any settlement proceeds paid to you depends on whether they properly perfected a “lien” before the suit was settled by you. In Louisiana, there is a special statute that governs medical liens on auto injury cases, La. R.S. 9:4752.
La. R.S. 9:4752 allows for a “medical lien” in favor of health care providers who provide services to an “injured person.” This statute allows health care providers to recover “reasonable charges or fees” from third party tortfeasors. Another statute, La. R.S. 9:4753 provides the exact steps the health care provider must perform to perfect the lien. If these steps are not followed, the lien can be disputed. There are also other legal methods to dispute the lien. Further, a client should always explore their related rights under Louisiana’s Balance Billing Act.
Finally, it should be noted, the charges health care providers will bill you for are almost always higher than the price an attorney can negotiate for you. For example, we pay a cash price for our client’s MRIs that is about 1/4 of the price your health insurance company will charge you for the same service. It is my unbiased advice to all, they should consider consulting an attorney before using their own health insurance to pay for their auto injury related treatment when they are not at fault for this accident. This is so because otherwise, the person may end-up paying 4xs as much for their medical care (which their attorney could have gotten 4xs cheaper) and which their health insurer will likely lien directly from any settlement proceeds paid to the person. Hiring an attorney can help you navigate the lien process to your benefit and ensure you obtain the highest quality medical care for the best amount. If you have already treated with your health insurance, hiring an attorney can also help you because the attorney can send a letter of guaranty to protect the health care providers from collecting against you until settlement proceeds are received and then the attorney can also attempt to negotiate you a lower rate of reimbursement to the health insurance company.
If you have questions about your auto accident and health insurance payments, you can contact Cliff Cardone at The Cardone Law Firm online at www.cardonelaw.com or by phone at 504-522-3333.