Medical Expenses

If you’ve been in a car accident, you’re going to have medical bills. Even with car insurance and health insurance to cover portions of the bills, there are often out of pocket expenses. That’s why we have clients often ask us the simple question: how will my medical bills get reimbursed?

Theoretically, 100% of the value of your medical bills should be included in any settlement offer that the insurance company makes you. With that, it’s important to note that this is different from how much your health insurance paid, and it’s different than what you paid out of pocket.

For example, if an MRI costs $1,500.00, your health insurance might negotiate with the company and get the price down to $750.00. You might be responsible for a $50.00 co-pay, and the insurance company would pay the remaining $700.00. However, even though you and your insurance company didn’t pay the full $1,500.00, the car insurance company is still required to reimburse you that amount.

Since insurance companies know that you likely paid less than the full amount of hte medical bill, they try to offer less. What they don’t want you to think about are all the health insurance premiums that you paid in order to get that reduced rate on your bill. Regardless, the insurance company has a few tricks up their sleeves.

In reality, there is a process through which the insurance company is able to legally show that the value of the medical bills is less than the full face value. That is by getting expert testimony about the range of payments that a particular facility accepts. In our MRI example, which the face value of the bill is $1,500.00, the insurance company would have to hire someone who could explain that the hospital will accept $400.00 from Medicare to perform that MRI, up to as much as $1,200.00 from some private health insurance. The jury would then decide what the fair value is.

As you can imagine, getting this specific information for every bill can take a lot of time, and cost a lot of money. So, the insurance companies try to take shortcuts. For example, they’ll get information about what the “usual and customary” charge for a procedure is, or they’ll figure out what the Medicare rate is, and they’ll reduce the bills to that amount. While it might make some logical sense, it’s not how the law works.

At Marcotte Law Firm, we’ve handled thousands of car accident and personal injury cases, so we’ve seen all the arguments. We understand what’s legal and what’s not. However, what it boils down to is cost vs. benefit. If you’re claiming $100,000.00 of medical bills in your settlement demand, you understand that it will make financial sense for the insurance company to get the necessary expert testimony. Similarly, if you’re claiming $5,000.00 in medical bills, are you going to want to go to court if the insurance company wants to only reimburse you $4,500.00?

In the end, each case is different. That’s why it’s so important to have an experienced car accident lawyer. This experience allows your lawyer to give you a fair and detailed explanation about whether your settlement is fair, or whether you should reject it and go to court.

If you’ve been in a car accident and you’re wondering how your medical bills will get paid, there’s no time to wait. Call the experienced car accident attorneys at Marcotte Law Firm for a free, no obligation consultation.