By: Karen Piso Nadeau, Esquire
In my prior blog, I addressed who pays your medical bills when you are injured in an automobile accident in Massachusetts. In summary, the car that you are in or the vehicle that makes contact with you provides the insurance coverage called personal injury protection benefits known as PIP as the first in line to cover your medical expenses. There is then a coordination of benefits with your health insurance paying your medical bills with many twists and turns. There are some clear rules in place to move your medical bills through the insurance process and get the bill to a zero balance. However, many things can get in the way of your medical bills getting timely processed and paid leading to unwanted stress and anxiety. This blog will explore some of the typical issues encountered with some guidance on how to maneuver through the not so friendly process and why it is important to deal with your outstanding medical bills.
More Insurance Coverage Does Not Mean Medical Bills Get Paid Timely
It would seem like a reasonable assumption to conclude that since there is more insurance to cover your medical bills available to you when you are in a car crash, then your medical bills would be timely covered and paid. The reality is usually just the opposite. Seeing a medical bill on your patient portal or in the mail with a zero balance is a welcomed sight and often quite a relief. However, since there is both the auto PIP coverage as well as your health insurance involved, things can get very messy and frustrating before it works itself out.
In the insurance industry, there is a coordination of benefits that must take place between the auto PIP insurance and the health insurance to determine who pays. Often, medical bills are stuck, and PIP and your health insurance are pointing the finger at the other as the reason your medical bill remains unpaid. Getting to the bottom of this tangled web takes patience and time. Eventually with persistence, the medical bills get paid. It is the norm for this process to take months to clear your bills.
What Does PIP Cover in Addition to Medical Bills?
This blog and my prior blog have focused on the medical coverage provided by personal injury protection benefits known as PIP benefits. It is important to know that the PIP coverage is also for lost wages incurred as a result of the auto accident and injuries suffered preventing you from working. There is typically a total of $8,000.00 in PIP benefits available for both medical bills and lost wages.
Sometimes we have clients who use the first $2,000.00 in PIP benefits for their medical bills. The PIP exhaust letter provides the necessary notice to their health insurance that they are now on the hook for the victim’s medical bills incurred as a result of the auto accident. There is then $6,000.00 still available in PIP benefits. PIP will pay 75% of lost wages. So, for example, if you are unable to work for 1 week and make $1,000.00 a week, PIP will pay you $750.00 lost wages with the necessary documentation needed. This documentation is usually a wage verification filled out by your employer and a doctor’s note stating that you are unable to work for the stated period of time due to the injuries from the accident.
It is a total of $8,000.00 in coverage that includes both medical bills and lost wages. It is not $8,000.00 for each. This lost wage component of PIP has proven invaluable for some clients who are out of work for an extended period of time and need the money sooner than later.
Some Common Obstacles to Getting Your Medical Bills Paid
As already summarized in this blog, navigating the insurance industry to get your medical bills paid when you are in an auto accident is no walk in the park. Sometimes, you think you have it figured out, only to discover another obstacle has been raised preventing your medical bills from being timely processed. We hear excuses such as PIP does not have the necessary billing codes from the medical provider to pay the bill or PIP is waiting for the medical record to make sure the bill is related to the car accident for example.
Other times the health insurance is refusing to pay the medical bill because PIP did not send the PIP exhaust letter that triggers the health insurance to pay. We also hear from medical billing departments that the bill is being processed and it may take 30-60-90 days. Sometimes this means the bill is stuck doing nothing until there is aggressive follow up to get the medical bill addressed that has been in limbo far too long. Our clients get monthly notices in the mail that medical bills are outstanding or see notices on their patient portal that medical bills remain unpaid. It causes a lot of unnecessary anxiety and worry, especially when so much time and energy has been spent working with PIP and the medical billing departments to make sure the bills get paid timely.
There is no magic here. You do the best you can to document everything and provide the information needed the best you can. The good news is that most of the time, your medical bills get paid between the PIP coverage and health insurance. It may not be on the timetable that we want and there are a lot of bumps along the way. However, in the end, it usually all works itself out.
What Can You Do to Help Get Your Auto Accident Medical Bills Paid?
The most important thing you can do to get your medical bills paid that are related to your auto accident is to give the billing department of the medical facility all the insurance information. This may means asking the person at the front desk of physical therapy who oversees medical billing information and giving it to them for example. Most treatment facilities are pro-active and will require the insurance information before you begin your treatment.
You must give both the PIP insurance information including name of PIP insurance company, claim number, claims adjuster, and phone/fax /email information as well as your health insurance information, usually the medical facility will take a copy of your health insurance card or scan it. It is then up to the billing departments to do their jobs and figure out how to bill, what they need to send, and get it done. Some run smoother than others.
There are times when medical billing does not have the necessary insurance information and sends you the bills to pay. We have clients sending us bills asking if they need to pay the bill. Often the answer is: No, you do not need to pay this. However, you do need to call the 1-800 number on the bill and give your PIP information and health insurance information for the medical facility to bill.
Sometimes the medical billing has no insurance information and the way they get your attention is to send you the medical bill in the mail or send you an overdue bill notice or even a collections notice. We see this often when a client goes to the emergency room for medical treatment after a car crash. An emergency room visit may generate several different bills from different departments. The fact that you told the emergency department about your insurance does not mean that the emergency physician billing or x-ray billing has this information. This would be too easy and practical. You would think the emergency department would share your insurance information with the other emergency care providers. But our experience is that they don’t share this information. Then our client receives a nice physician bill for over $1,000.00 or maybe radiology bills for $500.00 in the mail.
Taking immediate action and providing the insurance information to the billing departments when you receive the notice of the outstanding bill goes a long way to getting your bills processed and paid in a more timely manner.
Why Is It Important to Get Your Medical Bills Related to the Auto Accident Paid?
It is obvious the benefit of having your medical bills paid with zero balances and having that financial burden lifted from your shoulders. There are other important considerations when you have a personal injury case that you are pursuing for compensation- usually against the insurance company that insures the at fault negligent driver of the vehicle that caused the collision. There is an interplay between your medical bills and the ultimate settlement of your case against the responsible party. What this means is your medical bills, who paid them, patient responsibility for any medical bills, medical liens, and health insurance liens all need to be taken into consideration when you are making a decision to resolve your personal injury case against the at fault operator.
An experienced car accident attorney will know how to deal with these issues and best advise you on your auto case. However, knowing that you have zero balances and PIP and health insurance have paid all your medical bills often greatly helps to move your case toward settlement sooner than later. Having outstanding medical bills related to the car accident can delay settlement of your case and deprive you of the compensation you need and deserve. It is worth the time and energy to make sure your medical bills are addressed, and the insurance is paying your bills as they should in a timely manner. Not only is it peace of mind but it makes for a much smoother negotiation and settlement process when you are pursuing a bodily injury claim against the driver who caused you harm.
At Nadeau Harkavy LLC, we have over 60 years combined experience representing injured people and their families when they have been involved in an auto accident. We have recovered millions of dollars in compensation for our clients over the years to help them get on with their lives after suffering the consequences of a serious accident. We make sure everything is done to protect your interests while you and your family concentrate on getting better. We handle all types of car accident cases including wrongful death and brain injury. We represent drivers, passengers, pedestrians, bicyclists, motorcyclist and other type of car accident cases such as scooter or skateboard accidents. We also handle other types of injury cases such as trip and fall, slip and fall, dog bite, construction site, and catastrophic injury accidents. If you or a loved one has been harmed through no fault of your own, call us today for a free consultation about your legal rights at 617-674-7640.