If you Have Health Insurance, how do the Medical Bills get Handled?

If you have health insurance including private health plans, Medicare, Medi-Cal, Covered California or any other health care program including “Obamacare” programs, the medical provider is required to bill insurance but, may demand that you pay any co-payment amount “co-pays” or meet a deductible. What payments are made or what you are required to pay directly as an individual varies depending upon the terms of your insurance policy or health plan. One of the major issues that come up is when a person is transported by an ambulance or treated at a facility that is “out of network” for their health plan. Other times, medical providers simply attempt to collect the full amount from the patient without ever attempting to bill their health insurance. Still other times, medical providers attempt to “balance bill” or “surprise bill” patients even though they have already been paid by health insurance at the contractual rate (a practice which is prohibited by California law but, still takes place too often). Even if the health insurance provider is billed and pays out money, the health insurance policy can (and often does) assert “subrogation rights”. This means that they can demand to be repaid all or part of what they paid out on your behalf if they find out that you will be recovering money from a third party (or that person’s auto insurance carrier).

Many auto insurance policies in California have what is called Medical Payments coverage (or “med-pay”). This provides for payments of medical expenses up to a certain policy limit amount. It is usually a fairly low amount (most times less than $10,000) but, it certainly provides for another means to get the bills paid. Most (if not all) of these provisions also come with “subrogation rights” (or the right to claim reimbursement if you are awarded a settlement or judgment from the other party or their auto insurance carrier).

Some medical providers (including quality specialists like Orthopedic Surgeons or licensed physical therapists) can and do agree to treat patients with no upfront charges but, an agreement to pay the medical bills out of the proceeds of a personal injury settlement. This may allow for a person with no health insurance or a health insurance provider unwilling to approve treatment, an option to get necessary medical care including therapy, possible surgery or procedures such as epidural injections and even medications based upon a written agreement to pay for these services at the time of settlement of their car accident case. You should keep in mind that these agreements usually require payment regardless of the outcome of the personal injury case. Also, most medical providers are not willing to enter into a treatment on a lien basis unless and until an attorney has referred the patient and verified the validity of their legal claims to recovery.