Paying medical bills after auto accidents

[Stephen Tashiro]

I'm helping with the affairs of a couple involved in an auto accident. I understand how to handle their ordinary bills, but what about the medical bills? Much of the medical cost will be borne by Medicare, Blue Cross or the auto insurance companies. How does this get sorted out?

For example, they were both in hospitals in another city for over two weeks. The only medical bill they've received so far is for $150.00 for 2 days of "provider care" from a rehab hospital where one of them stayed. In general, does one pay medical bills and apply for reimbursement to one of the insurance companies? Or do the bills get sent to one of the insurance companies?

[Howard Garner]

Most places will file the insurance forms for them.
Wait for an explanation of benefits to find out what the users are required to pay as their part.

[Ken Fitzgerald]

Stephen,

It has been over 15 years since our youngest son was a college student, driving a car en route to the college library when a pickup ran a stop sign and broadsided his car. His medical bills went directly to the other driver's insurance company.

[Lee Schierer]

I think all you have to do is give the medical providers the insurance company names, including the auto insurance (theirs and the other party) and let the insurance companies work out who pays what. Eventually your friends will receive a bill for their part of the expense which may be minimal since it was an auto accident. You may need to ask their auto insurance company for help getting money from the other party's insurance company.

[Rich Engelhardt]

How long ago did this happen?

IME - the billing process of hospitals/insurance runs at glacial speeds.

[Ken Fitzgerald]

How long ago did this happen?

IME - the billing process of hospitals/insurance runs at glacial speeds.

60-90 days or more!

[George Bokros]

When a bill is received make sure to review who (insurance company paid) and be sure that any supplemental coverage has also paid before you pay anything.

Had an incident with my father, not accident related, my father paid the balance after medicare paid but not his supplemental insurance. He waited almost a year and finally called his supplemental insurance and they said they need how many units of anesthesia he received before they would pay. He told them from the bill he had that showed that info. They immediately issued a check and asked him to send a copy of the bill which he did. The doctor was happy cause dad had paid the balance. If the doctor has no skin in the game they do not respond to requests for info. Dad never paid again until the bill he received showed both payments.

Just my experience.

[Stephen Tashiro]

I think all you have to do is give the medical providers the insurance company names, including the auto insurance (theirs and the other party) and let the insurance companies work out who pays what.

That would be nice. It sounds too good to be true. The accident happened about a month ago and both friends are still in hospitals. One is still in an ICU. Last I heard the police investigation of the accident is not complete and my friends (obviously totaled) car is still "impounded" at $15/day storage costs to somebody. From my second hand info, the blame for the accident may lie with a red car that didn't stop afterwards. It or something caused a white car to swerve across the median on an interstate into the opposite lanes where my friends' car "t-boned" it. The driver of the white car was insured (and not hospitalized). Are insurance companies going to sort out a complicated case like this that could involve expenses for years of long-term car?

[Frederick Skelly]

All I have is my own experience here - YMMV. But assuming your friends have full coverage (i.e., collision, etc not just liability) from a reputable company (not Billy Bobs corner store), then file the claim with their company. They should sort out who should pay what.

And I THINK they should cover all of the mandatory costs subject to policy limits and deductables. I say mandatory b/c there may be some nice to haves (eg, private room vs semi private) that may not be covered unless they are a no kidding medical necessity.

Good luck. I hope your friends heal quickly. Its very kind of you to take this on and help.
Fred

[Mike Cutler]

Stephen

I'm in the middle of this with my wife right now. She was in an car accident in April of 2011. 100% the other driver's fault.
Each state will be different, so don't take this as etched in stone, but here's the basics, as I understand them.
The first $5k in medical was paid out no questions asked by our auto insurer. This number is reflected by the "aggragate injury per occurrence" line item on our auto policy. After that was expended, really fast, our Medical insurance kicked in and everything is subject to the terms of our medical insurance. Co-pays, deductible, out of pocket limits, HSA's, FLSA's etc. So far, I'm out of pocket about $5K over the past two years.
According to our attorney everything gets settled between all parties when a settlement is reached with the auto insurance company (s). Any monies our Medical provider is out will be attached to the settlement, as will our out of pocket expenses. The settlement to us will reflect the total settlement, minus reimbursement to our Medical provider, and of course attorney fees. Hopefully it will also reimburse all of my out of pocket costs.
We are at the 2 1/2 year mark in the process. It takes time.
As I said though, each state is different, and the subtleties involved I could't even begin to understand, or explain. They should absolutely have an attorney representing them. There is no way the layman will ever navigate the process by themselves, especially when there are physical injuries involved. If they don't already have one, get an attorney as soon as practical.

[Stephen Tashiro]

They should absolutely have an attorney representing them.

I agree and they got one. I don't understand the divison of responsibilities yet. When you get a bill, do you ask the attorney whether to pay it?

They don't have any urgent descisions to make at the moment. As other posters have noted, medical billing is a glacial process. I'm just looking ahead.

[Mike Cutler]

I agree and they got one. I don't understand the divison of responsibilities yet. When you get a bill, do you ask the attorney whether to pay it?

They don't have any urgent descisions to make at the moment. As other posters have noted, medical billing is a glacial process. I'm just looking ahead.

In our case, no I do not contact the attorney prior to paying a bill.
In the beginning he asked if would place a financial hardship on us to keep up with our co-pays, and I said no. He indicated that there were papers that could be filed if it did, but we would still pay them in the settlement phase.

I haven't found glacial speed yet. The doctors we've been to have pretty much right on top of it and compute the co-pay at the time of service. The insurance company can lag a bit though.

[Frederick Skelly]

This was helpful Mike. Thanks. Ill call my insurance guy tomorrow to check the medical limit on my own policy.
Fred

[Val Kosmider]

I would suggest that you be VERY careful in paying ANY bills out of pocket. The chances of seeing that money ever again once it goes 'into the syetem' is dramatically reduced.

What you might do is keep track of what you think any co-pays might be, and put that money aside.

It seems that your insurance, the white cars insurance, and the red car's insurance, plus Medicaid and any other plans which might com into play should cover it all. Plan A pays "X" less the deductible/co-pay; Plan B pays the outstanding deductible/co-pay. Etc.. You should end up with NO out of pocket expense.

I also believe that the insurance companies will sort through it between themselves. Again, at the speed of concrete, but it will get done. And you should not insert yourself into that process until/unless you are finding charges which you think should be covered are still outstanding. Their objective, after all, is to pay as little as possible--hence the reason why you don't pay ANYTHING until they are done with their shenanigans.

Good luck.

[Michael Schneider]

Stephen,

All states handle this differently. Get something for your tax dollars.

Here is the web site for the New Mexico Insurance Inspector, give them a call at (1-855-427-5674)
They may transfer you a time or two get you to the correct person.

Tip. At each transfer, Ask for the persons name and direct telephone number.

http://www.osi.state.nm.us/ (http://www.osi.state.nm.us/)

Good Luck, I hope your friends recover fully, and soon,
Michael

[Stephen Tashiro]

Here's an update. No party has been identified as being liable in the accident, so the liability numbers that insurance agents emphasize are irrelevant. The only coverage by any auto insurance policy will be the "personal medical expenses" coverage of $5000 per person involved in the accident that are on my friends' policy. (If you are going to be in a serious auto accident you better hope that somebody is to blame for it!) The lawyer (I assume) is handling communications with the insurance companies. According to him, the auto insurance company does not make direct payments to the policy holder or to health care providers. Instead, it's up to Medicare and Blue Cross to recover money they spent from the auto insurance company.

[Paul Wunder]

Your friends need an attorney not only for the reasons stated above, but also for the possibility of subrogation due to others being liable for the loss. If another party is deemed legally responsible for the accident, Medicare, and perhaps other involved insurance companies will seek reimbursements for the expenses they initially laid out. This is a complex legal process, and in the case of Medicare, it can be daunting. We were rear-ended two years ago and our medical bills totaled less than $1K. Medicare sent us a bill for $27K (including all non-accident related care). It took two years of haggling, but Medicare finally settled for $370.00.

[Mike Cutler]

Stephen

The point you're at is the point I've been at for over 2 years. The "other" insurance company doesn't pay anything until a settlement is reached. Maybe insurance company to insurance company they do, but the actual money to the people involved in the accident? nope.
Right now all of the medical bills for us have been covered by my plan through work. At the end I can expect a Lien to be placed against any settlement we receive by my provider to be reimbursed for their payouts. I'm out of pocket on co-pays to my medical provider, and until the settlement is reached I won't realize any of it back.
It's a "weird game".

[Larry Whitlow]

The medical payments coverage in a personal auto policy is considered "first aid" type coverage, hence the low limits. After that your health care insurance/provider will kick in. If another driver is at fault, your health insurer will expect, rightly so, to be reimbursed by the negligent driver's insurer. Your auto insurance company should also be making a claim against the negligent driver's insurer regarding any property damage (that is,damage to your car). An insurer of a negligent driver is not likely going to make payment via the liability coverage part of the policy until there is a settlement agreement. Either way, the negligent driver's insurer is not going to pay beyond the policy's limit of liability. So for example, if the negligent driver purchased only minimum limits required of say $30,000, then the insurer is not going to pay beyond that limit. Don't know what the minimum limit is for New Mexico. I would like to extend my best wishes for your friend's speedy recover.

[C Scott McDonald]

You could best help your friends by locating them an Attorney right away to be honest.