At McMullin Injury Law, our focus is personal injury law and one of our goals is to educate our clients about the process of settling a personal injury claim.  To that end, we are happy to answer questions that you might have about your case.  One that we get asked often by new clients is, “If I didn’t cause the accident, why do my medical bills get sent to my health insurance company? We believe this insightful question warrants an in-depth answer.

Determining Options  If, for example, you have been injured in a car accident and we represent you, one of the first things we determine are the options available for paying the medical bills.  Every case is different, but usually accident-related medical bills can get paid using a combination of the following four options:  No Fault (PIP) benefits, your own health insurance, out-of-pocket payments made by you, and the liability insurance of the at-fault party.

Utah’s mandatory No Fault (Personal Injury Protection, or PIP) benefits currently provide a minimum of $3,000 per person in an accident.  Granted, that amount doesn’t go very far these days due to the high cost of medical treatment, but we look to No Fault coverage as the first option for our clients.  After the No Fault benefits have been used up, or exhausted, the client’s health insurance (if they have it) is the next available option for paying those medical bills.  Now to answer the question we started with:  If a person didn’t cause an accident, why are the medical bills paid by their own health insurance?  There are three main reasons:

1.     When a medical provider’s office bills your health insurance, that provider can be paid throughout the course of treatment. Because you pay for the coverage, and the purpose of health insurance is to pay for medical treatment, it’s beneficial to use it.  While it is likely that you may have to pay a co-pay for each visit, that is far less expensive than paying out of your own pocket for each visit.  Most providers are willing to work with our clients if the treatment lasts over a period of months.
2. If you get treatment from a provider who is in your insurance network, the charges will be lower due to the contractual writeoffs that the provider agrees to accept as payment in full.  Therefore, each visit will not be as expensive as if you had to pay out of pocket.
3. When your case settles, a portion of your settlement will go to reimburse your health insurance because the company has the right to be repaid for the treatment you received because your accident was caused by someone else.  While not always the case, sometimes our office is often able to negotiate with the insurance company to accept a lower reimbursement amount.

These are the three main reasons that medical bills generated as the result of an accident are sent to your health insurance company.  If you don’t have health insurance, contact our office to learn about how we can work out other options with medical providers.

As mentioned above, the final two options involve out-of-pocket payments by our clients and, finally, settlements from the liability insurance company.  Because each person’s case is different, we work closely with you and the medical providers when these two options are used.

If you or someone you know has accident-related medical bills and have questions about how to get them paid using health insurance, contact our office at (435) 673-9990.  We have the experience and skills to work with health insurance companies.

At McMullin Injury Law we are… In Your Community and On Your Side.