While on the topic of health insurance, one of the biggest problems we have faced in recent years is the medical community refusing to file with an injured individual's health insurance, when the treatment would be covered.
Let’s say you fall asleep at the wheel, run off the road and injure yourself severely. You need months of conservative care and ultimately wind up with a back surgery. Your medical bills total over $100,000.00, but you are fortunate enough to have excellent health insurance through your employer or privately. All of your medical providers have contracted with your health insurance plan and are bound by the guidelines of these contracts in terms of what they can bill you personally.
Your health insurance carrier pays all of your expenses, less of course the co-pays and co-insurance and deductibles. You do not owe your health insurance company anything.
Now let’s say someone runs you off the road, causing the exact same injuries. Now that there is someone at fault, that has automobile insurance to pay you for your injuries. All of the same doctors and medical facilities will now refuse to file with your health insurance and instead file a medical lien with the insurance company for the other driver and with your attorneys.
These liens are for the full amount of the medical treatment and will not include the usual and customary write offs they would have to take through your health insurance. These doctors will refuse to file with any health insurance plans, including Medicare and Medicaid, if there is any chance they can get paid in full directly out of your personal injury lawsuit, rather than the reduced amount through health insurance.
Injured individuals should insist that the doctors and medical facilities agree to file with their health insurance plans at the onset of any treatment. Every health insurance plan has a right of recovery provision, which will guarantee them reimbursement out of any settlement or judgment you might obtain in your lawsuit. Your attorney will pay the health insurance plan only what they paid to the doctors. Moreover, the plans will usually reduce this amount for the attorney’s hard work on the case in obtaining their money back. This amount is much less than you would have to pay through a medical lien on your case.
For example: If your surgery cost $25,000.00 and your health insurance company would have paid that doctor $8,000.00, you would owe the doctor only your co-pay and deductible (if not yet reached). Let’s say it's a maximum of $2,500.00. At the time of settlement, you receive $100,000.00 because there is not enough insurance. Your attorneys would reimburse the health insurance carrier less than $6,000.00 and the other $19,000.00 that would have gone to the greedy doctor that filed a medical lien (instead of filing with your health insurance) will now go in your pocket.
Individuals fortunate enough to have health insurance in this day and age, are entitled to all of the benefits, whether or not their injuries are caused by someone's negligence. The attorneys at Lawter & Associates have years of experience in dealing with these issues and doing everything possible to prevent these doctors from receiving more than they are entitled to.
Tue, March 9, 2010
by Matthew Reinstein filed under