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Hoffspiegel Law Blog

The latest trend is for medical providers to refuse to accept health insurance when you are in a motor vehicle collision.  There may be several reasons for this.  First, they may have run into an insurer who refuses to pay for auto related injuries, trying (unlawfully) to place the onus on the third party’s carrier.  And others have a different approach…they will treat you, but not take your insurance coverage.  They will hold out for full payment from your settlement or judgment because it gives the hope of a larger payday than they would have in accepting what your health insurance will pay. 

It is common nowadays to go to a hospital for treatment and have them refuse to accept your health insurance.  They will ask questions about the liability coverage and if you have counsel.  They will then file a lien for the entire face amount of the bill (which virtually no one has ever paid), which may be far more than their insurance contracts allow.  And you cannot resolve the case without addressing the lien.

If you are told that a medical provider will not accept your health insurance and they are snooping around as to details of a potential claim, go elsewhere.  There are plenty of large and well respected orthopedic groups in town for example who will gladly take your health insurance.  The larger groups have many specialists and subspecialists who are more than qualified to treat you.  You don’t have to give the hospital any details about third party claims.  If they don’t want to treat you and it is not an emergency situation, go elsewhere.  You can call before you go to learn their policy.

The problem with medical billing today is that it resembles the Wild West.  There is a book with all listed reasonable and customary charges.  You will never see that book.  Providers have contractual agreements with many health insurers.  The contracted rates are far below the prices listed on the bill.  The only people expected to pay the full bill are those without any health insurance.  In those cases, hospitals will generally work with the patient, according to need.  There is a different and lower rate for Medicare.  Only a fraction of a bill is paid by Medicare and the patient is responsible only for the co-pay and some of us are fortunate enough to have a Medicare supplement.  Medicaid rates are even lower.  If you are in a wreck and are treated at a hospital, expected a large bill.  Just don’t let yourself be put in a position where you are paying them full freight out of your settlement.  Don’t allow them to recover additional profit because you were injured on a wet floor in a store rather than tripping over the rug at home.  Your injury.  Your recovery.  Protect yourself.