Paying Medical Bills After an Injury

Often one of the most daunting challenges facing people who have been injured is finding a way to pay their medical bills.  Money may be tight anyway because the injuries keep people out of work.  When injuries are a result of a car accident, people also have to worry about how to get their car repaired and the repairs paid.  This article will address some of the questions about using your health insurance, Medicare/Medicaid and the at fault party’s liability insurance to pay for the medical treatment you need after an injury.

Before going any further, it is important to note that the information in this article does not apply to injuries at work covered by workers’ compensation.  For information on how to get medical treatment for a work injury, click here.

Health Insurance

Contrary to what some doctors’ offices or hospitals may tell you, your health insurance will pay for treatment for injuries even if the injury was from a wreck or slip and fall.  We often have clients tell us that the doctor’s office or hospital refused to file with their health insurance because they were injured in a wreck or fall.  This is wrong and can cause you to pay more than you should for treatment.

Sometimes people tell us that they don’t want to file with their health insurance because the other person’s insurance should be responsible for their bills.  While the at fault party’s insurance will ultimately be responsible for paying you for your medical bills, failing to file with your health insurance can be a costly mistake.

The reason you want to file on your health insurance is that most health insurance plans have a contractual arrangement with doctors and hospitals that allow the health plan to pay a steeply discounted rate for the treatment you receive.  The discounted rate that the insurance plan pays is often only a fraction of the amount an uninsured person would pay for treatment.  If the treatment is not filed with your health insurance, the doctor or hospital will expect to be paid the full amount for the treatment provided, rather than the discounted rate.  This could end up costing you thousands of dollars in unnecessary out of pocket expenses.

Subrogation/Reimbursement

You may be asking why your health insurance company would pay these bills when your injury was caused by someone else.  The answer is that many insurance plans have provisions that allow them to get back what they have paid once the claim or lawsuit against the person or company that caused the injury is resolved.  These policy provisions are often called reimbursement provisions.  The plan language for your insurance policy will explain what, if any, reimbursement the health plan is entitled to receive.

If you are required to reimburse your health plan, it is still in your best interest to have your medical bills paid by your health insurance.  This is because of the contractual reduction mentioned earlier.  The health plan is only entitled to be reimbursed for what they have actually paid.  This amount will often be thousands of dollars less than you would have to pay for the same treatment if you pay out of pocket.

Medicare/Medicaid

Medicare and Medicaid will also pay for treatment related to your injury.  Unlike health insurance, Medicare and Medicaid are always entitled to reimbursement if you collect from the party that caused your injury.  Like health insurance, Medicare and Medicaid pay a significantly reduced amount to the doctors or other medical providers for the treatment you receive.  In addition to this benefit, Medicare and Medicaid will also reduce their claim for reimbursement by their proportionate share of attorney’s fees and costs.  So, while you will have to pay Medicare and Medicaid back at the end of the case, the amount they seek will often be only a small portion of what the medical bills would have cost you if you had paid them directly.

Medical expenses can add up quickly after an injury and can be overwhelming.  If you have questions about getting your medical bills paid after an injury or any other questions about your personal injury case, please schedule a free consultation with Ann-Margaret Perkins by simply calling the number at the top right or filling out the “Need Help” form on this page.