It is a common misperception that the other driver’s automobile insurance is required to pay your medical bills as you receive them. In fact, the other driver’s automobile insurance will likely issue you one lump sum payment as settlement of your claim, including reimbursement for 2 your medical expenses, which you must in turn repay to your own health insurance company or any auto insurance that initially paid the medical bills. Who should be paying your medical bills depends largely on what insurance and other resources are available to you.
If you have health insurance: Your health insurance company should pay your medical bills related to the accident and you should submit to your own auto insurer your copays, deductibles and other medical expenses not covered by your health insurance company, as discussed below. This is true even if you were not at fault for the car accident, and even if there is other auto insurance coverage with medical expenses available to pay your bills. Most health insurance policies provide that they must be repaid if you recover from the other driver’s insurance company. However, you should continue to submit all of your medical bills related to the car accident to your own health insurance company, as this will likely save you money in the long-run. Your health insurance company may have contracts with some of your medical providers that allow them to pay a reduced rate for your medical care and therefore you repay your health insurance carrier a lower amount than if you had paid the medical providers directly the full dollar amount. If you are insured through Medicaid or Medicare, they also will continue to pay your medical bills until you have reached a settlement or obtain a judgment against the other driver. You will be legally required to repay them out of the settlement proceeds, if and when you receive money from the accident.
If you have health insurance and also have medical payments coverage under your own automobile insurance policy or an auto insurance policy for the vehicle in which you were a passenger: We usually recommend that you submit to your auto insurer only your deductibles, copayments, mileage to and from your medical appointments and other medical expenses that are not covered by your health insurance company. There are several reasons that we usually 3 recommend this. First, you will be able to have more of your medical bills paid through insurance instead of out of your own pocket. Since auto medical pay benefits often have very low limits, submitting all of your medical expenses to the auto insurer often will exhaust those limits at any early stage, leaving you with no insurance to cover expenses that your health insurance company will not pay. Also, if you submit all of your medical bills directly to the auto insurance company, they will likely pay the full dollar amount of those bills and not a reduced amount, like your health insurance company pays, and therefore you will end up repaying more money when you finally resolve your case.
Sometimes medical providers will request that you submit their bills directly to your automobile insurance provider; however, if your health insurance provides coverage for the care they are providing, you should submit those bills to your health insurance provider, not directly to your automobile insurance provider.
On a number of occasions, victims of auto accident injuries with whom we have spoken mistakenly believed that the other driver’s auto insurer should or would promptly pay their medical bills, and did not turn the bills in to their own health insurer or auto insurer, resulting in delinquent bills, collection threats, and even lawsuits against them by medical providers. It is important to understand that the other driver’s insurance company has no obligation to pay those bills, and in fact has no obligation to you at all concerning your claim. Their only duty is to defend their insured – the other driver or owner of the other driver’s car and to pay any judgment against their insured if a lawsuit is filed. While it often makes business sense for the other driver’s insurance company to settle your claim in order to avoid the time and expense of a lawsuit and trial, it has no obligation to do so, and no real incentive to do so promptly.
If you do not have health insurance: You may be able to have some of your medical bills paid by your own car insurance through medical payments coverage, but only up to the amount of coverage you have under that policy (often $5,000). You also may be eligible for medical care under state of federal programs. IowaCare is a program that will pay for certain medical care for some people who are not eligible for Medicaid. Participants in IowaCare are required to obtain medical care from participating providers, including the University of Iowa, Broadlawns Hospital in Des Moines and People’s Community Health Clinic in Waterloo. A social worker for the hospital where you are being treated may be able to help you apply for this program. Children that are not insured may also qualify for a program called hawk-i which provides coverage for children whose families do not qualify for Medicaid, but still have limited income. More information about this program can be found at www.hawk-i.org. If you are eligible for or are already receiving Medicaid or Medicare, you should submit all medical bills from the accident to those programs. There are complex rules, procedures and formulas for reporting any money you recover for your injury claims to those programs and for repaying all or some of the money paid by Medicare or Medicaid.
If you receive emergency care from a hospital, the hospital may file a lien under Iowa’s amended hospital lien statute to recover its charges from any recovery you make. Recent changes to that law limit the amount that a hospital can recover and require that it be reduced by the hospital’s share of your attorney fees and lawsuit expenses. In addition, if you have no insurance, some medical providers will be willing to wait until your claim is resolved before recovering what you owe them. The key point is this: as discussed above, you must receive necessary medical care in order for your injury claim to receive fair consideration by the other driver’s insurance company and attorney, and ultimately by a jury if you do not settle your claim. An Iowa attorney familiar with these issues and resources can assist you if you have no insurance.
An Iowa personal injury attorney can help you to figure out the best way to maximize your recovery of medical expenses and often can help you to reduce the amount that you must repay to medical providers, insurance companies and other programs that initially pay your medical bills.