Medical Payments Coverage

Published on May 17th, 2019

My husband was seriously hurt in a motor vehicle accident. The hospital is telling me that his medical payments coverage on our auto insurance policy is his primary insurance and refusing to bill our health insurance for its services. What should I do?

Answer: Call an injury attorney. Hospitals often take the position that medical payments coverage, personal injury protection (PIP) coverage, and/or the auto liability insurance coverage of the driver that caused your injuries, is considered “primary”. This is a fancy way of saying that hospitals will oftentimes try to send their bill to these sources of recovery as opposed to processing the bill through your health insurance. Hospitals do this because they feel that they can get 100% of the bill compensated through med-pay, PIP, and/or liability insurance, whereas health insurance will compensate their bills at a reduced rate.

At first blush this may seem harmless. So long as the hospital’s bill gets compensated, what is the difference? The “difference” in what source a hospital bills is extremely important to you.

Med-pay and PIP coverages can be used to cover differences between what health insurance pays a hospital, physician, physical therapist, etc. and that provider’s total bill. This means that rather than having a hospital simply use up all your med-pay and PIP coverage immediately, you can save this money for later on down the road should you or a loved one require extensive medical treatment that your health insurance does not fully compensate. In significant injury cases, saving your med-pay and PIP money in this fashion will save you significant out-of-pocket expenses in what could be a very difficult financial time.

Additionally, allowing a hospital to “bill” the auto liability insurance of the individual causing your injury is harmful. Auto liability insurance carriers do not simply pay hospital bills. Instead, these companies can and do fight resolution of motor vehicle collision, trucking negligence, and personal injury cases for years. This results in your bill not being paid, the time period for submitting the bill to your health insurer expiring, and the hospital attempting to collect 100% of the bill value from your injury case (when it is resolved). In layman’s terms, this leads to you losing a greater amount of your overall injury case recovery than if the hospital rightly submitted your bill to health insurance.

At Ryan, Ryan & Viglione, we counsel injury clients through the process of having their medical bills compensated via the appropriate source. We obtain med-pay and PIP coverage free of charge and present clients with lump sum checks for these amounts to help them in their times of medical and financial need. Through taking these steps, we ease the strain that serious injuries have upon you and your family, and we also ensure maximum recovery when your injury case resolves. Contact us today.

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