The short answer is yes, your health insurance should cover the medical treatment you receive for your injuries.
A crash resulting in severe or life-threatening injuries is probably one of the very reasons you signed up for healthcare insurance in the first place.
Insurance is betting that you won’t become injured or sick and you are betting you will. So when you are injured in a car accident, it’s time for the insurance company to pay up.
In an ideal world, when you’re injured in a collision through no fault of your own the insurance company covers all of your much-needed medical expenses.
The long answer, unfortunately, is a bit more complicated.
What Kinds of Health Insurance Covers Medical Care After an Accident?
After a car accident, getting medical care can be a confusing experience, especially if there is more than one insurance company involved. You may be unsure which insurance coverage to use to pay for medical bills and other costs.
Standard health insurance, personal injury protection (PIP), and medical payments coverage (Med Pay) are ways in which a person can cover the costs of medical treatment after a wreck.
PIP and Med Pay come from auto insurance coverage and are typically used first before your health insurance. In Georgia, these are not added to your coverage unless you request they be added. If you do not have PIP or MedPay as part of your car insurance policy, we highly recommend you sign up for them.
If you have PIP and/or Med Pay insurance coverage, you should use up those before filing a claim with your health insurance. Both usually do not come with deductibles (the amount you have to pay before insurance starts to cover items).
This means that if you get medical treatment for a car accident injury and the treatment cost doesn’t exceed your PIP/Med Pay coverage limits, you may not have to pay anything out-of-pocket.
Another advantage is that most health insurance plans have what’s called a “subrogation clause.” In cases where you are owed any money related to reimbursement of healthcare costs, that money is instead sent to the health insurance company as a way to recoup costs. PIP and Med Pay coverage can help mitigate this.
What Exactly Are PIP and Med Pay?
Georgia is an at-fault state which means that one or more involved parties may share blame for causing a car accident. Once fault has been determined, the responsible party and their auto insurance company are liable for damages.
PIP insurance is an optional form of coverage. It provides protection for more than just medical bills. It also covers the following damages:
- Emergency services, physical examination, surgery, medical treatment, and outpatient services for both the driver and passengers.
- Recurring medical fees such as rehabilitation services (physical therapy, medication, medical equipment, etc.)
- Lost wages that result from missing work while receiving treatment for accident-related injuries as well as future lost wages if the accident impacts your ability to work.
- Essential services if there are debilitating injuries that prevent a driver from maintaining household chores and child care.
- Funeral fees if there is an accident-related death.
Each service or benefit depends on an injured driver’s circumstances. You must prove your need for each benefit as the insurance company will not offer these automatically.
Med Pay insurance (sometimes abbreviated as MPC) works similarly to PIP. This type of coverage is like a health insurance policy for any occupants involved in a car wreck in your vehicle — regardless of who is at fault.
The insurance company will pay for “reasonable and necessary” medical expenses up to the limits of the policy. If the insurer pays the providers under your Med Pay coverage, you typically do not have to repay this money back.
There are some conditions where the Med Pay carrier may claim a right to be reimbursed if they can prove you have been “made whole,” or fully and completely compensated for your injuries.
This is yet another time when an attorney should be consulted and hired to step in and protect you.
Co-Pays and Deductibles for Car Accident Injury Bills
Treating a wound caused by a crash is no different than going to the hospital for any other kind of injury or illness. You receive medical care and pay the necessary co-pay or deductible as described by your healthcare plan.
A doctor or hospital may not require immediate payment. Most are willing to work with their patients to determine who needs to pay what.
Car accident injury bills are often paid following a basic order of responsibility:
- The first piece of the pie insurers or a doctor will look at to cover medical costs after a car accident is in your auto policy. If you have PIP and/or Med Pay, costs will be covered through those first.
- If your healthcare insurance coverage paid your medical bills first, they will make a claim against the auto insurance company that insures the at-fault driver to be compensated.
- Once all other forms of payment are exhausted, your health insurance will have final financial responsibility for treatment related to your car accident injuries.
However, injured patients may still have to pay their deductible, co-payments, and any charges not typically covered by the health policy.
This is why it’s so important to talk to a personal injury lawyer. Who’s responsible for what bill can quickly become overwhelming and you could be caught in the middle of the insurance companies and hospital’s haggling.
Call our knowledgeable Atlanta car accident attorneys today at (770) 934-8000 to discuss your personal injury case.
Health Insurance Often Comes With Strings Attached
Unless you have Medicare or Tricare, your health insurance comes from a for-profit company. Their goal is to make money, often at the expense of the health and well-being of those who rely on them.
If you have health insurance, make sure that you are persistent in getting all of your healthcare providers to bill your health insurer. They may try and tell you that your health insurer will not pay your bills. This is false.
If your doctor accepts your health insurance and you have complied with the terms of the policy, your health insurer cannot reject your claim because it was a car wreck.
Follow up with all of your carriers to make sure they have your health insurance information and that they have billed your health insurer.
Some hospitals will hold medical bills instead of submitting them to health insurance if they know you have a potential personal injury claim.
Why? Because the hospital enters into a contract with the health insurer where they agree to a reduced rate for their bills.
For example, the regular price for one X-ray might be $250. However, the hospital agrees to reduce the bill to $40 for the health insurer. If the hospital puts a “lien” on your personal injury recovery, they will claim a right to be paid the full $250, not the $40 negotiated health insurance amount.
If your health insurer pays for the bills you incur because of a car wreck, they may also put a “lien” on your personal injury recovery. In some situations, the health insurer may have a right to be reimbursed.
The only way to determine whether or not the health insurer must be repaid out of the recovery is to have an attorney review the health insurance plan language. If the plan is guaranteed a right of recovery, we often get the insurer to reduce the amount of their lien substantially.
Another reason to use your health insurance is to help prevent your medical bills from going to a collection agency, potentially harming your credit. Also, the doctor’s office may not be willing to treat you in the future if you have health insurance and you do not allow them to bill it.
Any time you go to any health care provider for treatment of the injuries you sustained in the car accident, make sure you give them your insurance information.
If no other source of insurance exists, then your best bet if you need continuing treatment is to work with an attorney to help find a doctor who is willing to treat you on a “lien” basis.
Read More: How to Get Medical Treatment After a Wreck When You Don't Have Health Insurance
Consult With an Attorney About Your Car Accident Injuries
We understand your frustration and can help untangle the confusing web of healthcare insurance and auto insurance. You’ve most likely invested a huge chunk of money into insurance for this exact scenario; you deserve to be taken care of and compensated.
Don’t let the insurance company, collection agency, or hospital ignore your rights and make you pay for something that wasn’t your fault. Talk to our experienced team of car accident injury lawyers today.
Whether you have health insurance, went to an urgent care facility, or don’t have any health insurance, we can help find a way to get you the treatment you need to heal and return to normal.