The Law Office of Doug Goyen represents people who have been injured in car accidents. Since 1997, our firm has handled car accident injury cases. In the event of an accident, health insurance may cause reasonable people to disagree on what to do. Call us for a free consultation. We can assist you in determining what you should do in your situation so that you receive the compensation you deserve for your injury. There is no fee unless you win. Call us at (972) 599 4100 and speak to our Dallas health insurance accident lawyer.
Health Insurance and a Visit to the Emergency Room After a Car Accident
The use of an injured person’s health insurance to pay medical bills resulting from an auto accident can help or hurt your auto accident injury settlement in certain situations, depending on the injury, the amount of liability insurance available, and how much your health insurance pays. If you are not careful, your health insurance company may take your entire auto accident injury settlement to pay themselves back and leave you with nothing to compensate you for your injury.
When you are injured in a car accident, rushed to the hospital, and concerned about your or a family member’s health, one of the last things on your mind is your health insurance. You’re assuming it’ll cover the visit because it’s an emergency, right? Surprise billing occurs when you go to the hospital and the hospital accepts your health insurance, but the doctors, radiology department, lab department, or other specialists do not accept your health insurance and send you their separate and entire bill.
If this happens to you (or you suspect it will when the bills start coming in), and the bills are more than you can afford, you should contact an experienced personal injury lawyer to see if they can assist you with your case. We can coordinate the claim with your health insurer, the auto insurance companies involved, and any other parties or insurers involved to ensure that you are following your policy, following the law, and maximizing the benefits you are owed and paid for. If another person was at fault for the car accident, an experienced personal injury lawyer can ensure that the negligent person’s auto insurance pays for and reimburses you, as well as any health insurance you may have – if any.
Should I Use My Health Insurance If I’m Injured in a Car Accident?
With health insurance, workers compensation insurance, auto insurance, and medical facilities that may or may not accept specific types of coverage, the answer to this question cannot be given in a yes or no fashion without first discussing the factors in your specific case.
There is nothing wrong with filing a car accident injury claim using your health insurance. In fact, after discussing the facts, I frequently advise my clients to use their health insurance for auto accident injury emergencies and medical bills. However, each case is unique, and different circumstances may necessitate different advice.
For a free consultation about your case, call (972) 599 4100.
To recoup their money, your health insurance can file a claim against your auto insurance
You can choose whether or not to use your health insurance. If you are involved in an automobile accident, you can use your health insurance if you need it – even if you have automobile insurance that “should” eventually pay. You should discuss your case with our car accident injury lawyer to better understand the pros and cons, as well as how to legally present your claims to the various insurance companies for the best possible outcome.
Your health insurer “may” try to take all of the money available from your auto insurance policy, leaving you with nothing to cover your out-of-pocket expenses. You may not realize it, but the claims adjuster for your auto insurance will eventually contact your health insurance and ask if they have a “subrogation clause” in their policy (a subrogation clause is a collection clause that allows your health insurer to receive the first money from your auto insurance claim). These subrogation/collection clauses are found in almost all health insurance policies.
If you do not have an attorney, this collection clause in your health insurance frequently results in the auto insurance company sending your entire settlement amount for your injury to your health insurer rather than you. You must retain the services of an attorney to protect your rights and ensure that you receive compensation for your injuries.
Common questions about medical care and health insurance after a car accident that results in an injury
1) Will my health insurance cover my medical bills as a result of a car accident injury?
Your attorney can assist you in compelling all insurance companies to pay the portion they are obligated to pay. Yes, your health insurance should cover any treatment that is covered by the plan, but you will most likely need the assistance of an attorney to ensure you make your claims properly and ensure you maximize your compensation.
One of the most common misconceptions is that an auto accident injury cannot be covered by health insurance. This is not correct. If you have health insurance, provide this information to the hospital, ambulance, doctors, and anyone else who treats you for your injury.
Your health insurance cannot refuse to pay the claim. There are several reasons why your health insurance company may not deny coverage simply because you “might” be able to get the auto liability insurance to pay.
You may be confident that the other driver’s liability insurance will cover the damages, but you could be wrong. Many issues can arise, causing the auto liability insurance company to refuse to pay. Remember, it is the adjuster’s job to look for coverage issues so that they do not have to pay if there is a coverage or liability issue. They will continue to look for these problems even after they have allegedly “accepted liability.” In Texas, they can change their minds and later claim that earlier payment made when they thought they should be paying the claim was made in error.
You really have no choice but to use your health insurance upfront due to the uncertainty of relying on another person’s automobile liability insurance. Your health insurance policy will include a provision that allows them to collect against the auto insurance in the event that the auto insurance pays the entire claim, but in many cases you will not want to take that risk with your financial future.
2) Who will pay my medical bills if I am injured in a car accident?
If you have health insurance, auto insurance, and the other driver has auto liability insurance, you may be able to get your bills paid through a variety of channels. The issue is that if you use these coverages in the wrong order, you may be unable to use one or both of them. To ensure that you legally maximize your available coverage, you must present the bills in the correct order. None of the insurance companies involved want to pay anything if they can avoid it, so they will not provide you with the information you need to properly present your bills and case. Indeed, because their job is to avoid paying as much as possible, they will frequently mislead you into presenting the claim in a way that allows them to deny payment.
3) Do I have to see the doctors on my health insurance plan, or can I go somewhere else?
The Law Office of Doug Goyen will assist you in getting into a medical facility as soon as possible to ensure you receive the treatment you require. You won’t have to wait for your auto insurance to “approve” the doctor you want to see. Depending on your situation, you may be required to see a doctor on a “letter of protection” – a guarantee from our office to the doctors involved that they will be paid once the auto insurance company releases payment for your injury claim. Alternatively, you may wish to use your health insurance and personal doctors whom you are already familiar with and who are involved in your care. We will go over your options to see which one is best for you in your specific situation.
The auto insurer will prolong your case as long as possible in order to avoid you seeing a doctor at all. Automobile insurers will never “approve” any doctors… ever. If you need to see a doctor, our attorney will get you in as soon as possible, often immediately.
If at all possible, the insurance company would like to pay nothing or as little as possible. The insurer may appear to be fine at first, but Texas courts allow an auto insurer to initially accept liability and then change their mind later if the insurance company claims to have “discovered” new information. This occurs when the insurance company “claims” you provided them with new information in a subsequent conversation, or that they reviewed your statement and now realize they made a mistake earlier. Attorney Goyen can ensure that you do not need to speak with the adjuster directly and will eliminate the risk of saying something that they will try to twist into an excuse for changing their mind and later denying your claim.
The auto insurance company may make “suggestive” statements about their willingness to pay your medical bills – but these are not guaranteed by the auto liability insurer. If you ask the auto liability insurance company for a written guarantee that it will pay all of your medical bills resulting from the collision, the typical response is, “We are still investigating; once we are done, we can talk about that.” That is, they will not guarantee anything. They will never do so. You can’t wait for them to approve anything because the auto insurer won’t approve anything.
Our health insurance accident lawyer will assist you in seeing any doctor you require for your injury. We will assist you in obtaining an appointment with the appropriate doctor for your injury. Our legal team will make certain that you receive the treatment you require in order to recover and protect your rights.
An insurance adjuster’s job is to pay you as little as possible, including not paying at all if possible. If you find yourself in this situation, contact a personal injury attorney to see what can be done to assist you.
4) Why won’t my personal doctor see me for an automobile accident injury?
Many doctors refuse to see patients with auto accident injuries. Signs in the lobby of these doctors’ offices frequently state that they do not see patients for auto injury cases.
They typically do not want to see patients for automobile accident injuries because these can be “disputed” claims. This means that there is a chance of litigation at some point. Doctors dislike being summoned to court to testify in automobile cases. They would rather stay in their office and see their patients (that is how they keep their doors open). Most doctors dislike going to court to testify about one of their patients’ cases.
5) Should I have my health insurance pay for this?
There are several reasons why you might want to have your health insurance pay upfront instead of waiting for your auto insurance to pay. I’ll list a few of the more common ones below:
a. Potential Liability Issues – Revised Story: First, when you go to the emergency room, you may believe that the other person’s insurance will eventually pay. The problem is that the other driver may change their story to their insurance company. They may say one thing to you and the police at the scene of the car accident, and then later when they speak to their insurance company, they say that YOU caused the car accident and that the police never asked them for their side of the story, and then they come up with a “witness” in their favor. This happens all the time; don’t think it won’t happen to you. To protect yourself financially, in many cases you may need your health insurance to cover your bills until the liability can be sorted out.
b. Coverage Issues with Other Driver’s Auto Insurance – Unpaid Premium: Another reason is that you don’t know whether the other driver paid his premium that month. He may have his insurance card, which indicates that he has auto insurance, but what if he forgets to make his payment, or if the check he mailed in bounces, and the insurance company says 2-3 weeks later, “Oh, we just realized, our insured did not make his payment on time.” We’re not going to pay for anything else on this claim… Denied due to a lack of coverage.”
c. Auto Insurance Coverage Issues with Other Drivers – Insurance Contract Violation – Incorrect vehicle, incorrect driver, no permissive use, excluded driver, and so on: Other factors may render the insurance ineffective. If the other driver is driving a vehicle that is not listed on the policy, coverage may be void. If he allows his driver’s license to lapse, he may not be covered. If he lied on his application for auto insurance, his insurance company may try to deny coverage. If he was listed on the policy as an “excluded driver,” he might not be covered. If he was living in the insured’s home but was not listed as a driver at the time of the accident, he might not be covered.
d. Failure to Report to Insurance Company: If the other driver fails to report the claim to his or her insurance company, his or her insurer may attempt to deny coverage. Some people put off calling their insurance company because they don’t want to deal with them. Some people, believe it or not, are unaware that they are required to contact their insurer following an accident, so they never do. Perhaps they are unaware of the requirement. Perhaps they are older and unsure of their obligations in reporting the accident to the insurance company. Whatever the reason, if they do not cooperate with the insurance company, the insurer can attempt to classify this as “non-cooperation” and use it as an excuse to cancel the insurance contract for this claim. If this occurs, there is a possibility there will be no insurance.
e. Amount of Coverage: You have no idea at the start of your case whether the auto insurance is adequate to pay for the treatment you require (the auto insurance may have low limits – insufficient to cover everyone’s medical bills if there are multiple people involved, or if your injury develops into one that requires surgery or another expensive type of treatment, the auto liability insurance may be insufficient).
f. You unknowingly say something that the insurance company uses against you: You may inadvertently say something to the auto liability insurance company that makes it appear as if you were partially or completely at fault. Frequently, auto insurance adjusters will try to “lead you” with questions designed to get you to say something that will allow them to say, “Aha! You admitted that you did _____, which means you were actually at fault – or at least partially at fault.” If this occurs, they will not pay your bills.
g. Lump Sum Settlement: Finally, even if the auto insurance company accepts liability and provides coverage, they will not pay your bills as they arrive. They will wait until you have completed your treatment for your injury, and then they will want to make a lump-sum settlement with you for the entire personal injury claim (for EVERYTHING related to your injury claim) – all to be paid out of whatever amount they offer. So, if you are still in need of treatment or require surgery for a torn ligament, it could be months before you can settle your claim.
The hospital bill collectors will not wait for your personal injury claim to be settled. They will call you, press you for payment, and report you to credit bureaus for non-payment of medical bills… all while you are waiting to be fully healed so that you can try to settle your personal injury claim with the auto insurance company. Most people don’t want their credit ruined by unpaid medical bills; in some circumstances, you may need to get them paid by health insurance, and then reimburse the health insurance from the auto insurance settlement when the case is ready to settle.
Just because you see a valid insurance card does not mean your auto accident injury claim will be covered. The auto insurance company is constantly looking for any reason not to pay the claim. They will use it if they find one.
6) I have a high deductible as well as copays. What if I decide not to use my health insurance for those reasons?
In some cases, your attorney may still recommend using your health insurance – depending on the circumstances. The hospital bills will be “adjusted” for you by your health insurance. That is, hospital bills are frequently cut in half or more due to the “contractual rate” your health insurer receives from any medical providers who accept your health insurance.
The hospital bills that you are supposed to pay towards your deductible will be applied to your yearly deductible – so this actually helps you if something else comes up later in the year – you will have already met your deductible due to this claim. Your attorney’s job will include informing you of settlement amounts and discussing your case with you so that you and your attorney can ensure that your settlement covers your deductible, health insurance, and anything else you are owed as a result of your injury.
7) What if I don’t have medical insurance? How am I going to pay for a doctor’s visit?
Letter of Protection: If you do not have health insurance, personal injury lawyers maintain a list of doctors in your area who accept “letters of protection” to see you for auto accident injuries. If you do not have health insurance, this allows you to see a doctor determine the extent of your injury, and receive the treatment you require.
8) What exactly is a letter of protection?
A letter of protection is a letter sent by an attorney’s office to a medical facility guaranteeing that the medical facility will be paid out of any automobile insurance proceeds from the accident. Car insurance does not pay bills in the same way that health insurance does. They do not pay bills as they come in. Auto insurance companies will not make a “lump sum” offer until you have finished all of your treatments. They might not offer enough to cover everything if you don’t have an attorney.
9) Can I see a list of doctors on a letter of protection?
Patients on letters of protection are seen by a wide range of doctors. Orthopedics, chiropractors, physical therapists, neurologists, surgeons, and general practitioners are among those who will accept patients on letters of protection.
Unfortunately, not all doctors or medical providers will accept a protection letter. If you are in this situation, you will need the assistance of an experienced Dallas car accident lawyer who has a network of doctors who accept letters of protection in order to obtain the necessary treatment.
10) Should I hire a lawyer if I’m using my health insurance?
Yes, you should hire a lawyer if you have been injured in an accident. You should consult an attorney at the very least, and you will almost certainly need to hire a car accident lawyer in these situations. You don’t want to jeopardize your auto insurance claim or your health insurance coverage by breaking the terms of the contracts or even unknowingly break the law. You need an experienced auto accident attorney who understands how these coverages work and interact with one another to ensure that your claim (or claims) are processed legally and correctly and that you do not jeopardize your available coverage or violate the law.
When dealing with multiple insurers (auto insurance, health insurance, Medicare, Medicaid, workers compensation, and so on), the laws and your rights can become very complicated. It is all too easy to jeopardize your case and break the law by doing the wrong thing. If you are dealing with multiple insurers, you should consult with an experienced attorney.
In many cases, if you are injured in a car accident, you must and should use your health insurance. There may be times when you do not want to use it. An experienced health insurance accident lawyer should be able to advise you on when you should and should not use your health insurance. For over 23 years, our office has successfully navigated and worked health insurance claims in Texas (since 1997).
Your auto claim may be impacted by a variety of private health insurance plans, Medicare plans, Medicaid plans, ERISA plans or other workplace sponsored health insurance plans, state government plans – city plans – or other municipal plans, CHAMPUS or TRICARE plans, disability plans, PIP, MedPay, uninsured motorist, other auto insurance plans, and a plethora of different combinations of these aforementioned plans. You should consult with an attorney about your situation to determine the consequences of each decision, so you understand how and why each available coverage can be used to maximize the amount of money you are legally able to receive.
The combination of health insurance and auto insurance (along with other possible benefits you may be entitled to or need to use) complicates these cases more than most people realize.
11) Why should my health insurance be compelled to pay when someone else is at fault?
You want to protect your finances. If a problem arises with the other person’s auto insurance – whether due to coverage issues, liability issues, a dispute over whether your treatment was necessary for your injury, a dispute over whether your injury was preexisting or not, or any other problems with the other person’s insurance – and it turns out you cannot legally force them to pay, you will have had to use your health insurance.
Many health insurance policies will not cover your bills if you do not submit your claims to your insurance company within a certain amount of time. In the case where you decided not to use your health insurance because you relied on the other driver’s liability insurance.
After a few weeks or even months, if the auto insurer decides not to cover your claim, or does not cover the entire claim, you will be personally liable for the medical bills. Because your auto liability insurance decided to deny or partially deny the claim for some reason, and you chose not to present the bills to your health insurer, they will not cover the claims due to the delay in presenting those bills. You now owe money on the bills.
Do not put yourself in such a position. You should think about using your health insurance to pay for your hospital bills upfront. An auto accident lawyer can assess your situation and recommend the best course of action for you. We can ensure that everything is presented properly, that all information is given to all insurers correctly, and that you have used the insurance coverage available in a proper way to maximize any coverage you may have and the compensation you receive for your injury.
If the auto insurance is found to be valid and they accept full liability, your health insurance will be reimbursed. In some cases, this may take some time, but the health insurance company will eventually get their money back. So they don’t lose anything; if liability is proven and coverage exists, they get their money back.
If you are unable to prove liability OR if there is no coverage, you have saved yourself from having a large hospital, ambulance, ER doctor, and ER radiology bill levied against you personally. (If you do not submit your claim to your health insurance company within a certain time frame, many health insurers will refuse to pay the claim – so don’t wait, submit it now – they will get their money back if there is coverage and liability against the other side.)
HIRE A CAR ACCIDENT PERSONAL INJURY LAWYER
Car accident lawyers work on a “contingency fee” basis, which means you don’t pay anything unless they win your case. If the personal injury lawyer is successful in the case, they will receive a percentage of the money recovered – it is essentially a performance-based contract. The better they serve you and your case, the more they are compensated. If it is discovered that there is something wrong with the case (for example, if the other driver allowed their auto insurance to lapse and there is nothing else), the personal injury lawyer will not be paid and will have worked on your case for free. If you find yourself in this situation, you have nothing to lose by contacting an experienced personal injury lawyer to see what they can do for you.
Doug Goyen has handled thousands of cases and recovered millions of dollars for his clients as a car accident injury lawyer in Dallas, Texas. His experience, training, and knowledge equip him with the tools to ensure you get the best representation possible for your case.
If you 1) have used your health insurance after an auto accident, 2) need to use your health insurance after an auto accident, or 3) want to know if you can or should use your health insurance after an auto accident, Doug Goyen can help guide you through the process to protect your rights and ensure you are properly compensated in your case. For a free initial consultation, contact us at (972) 599 4100. Unless you win, there is no fee.
To ensure that your claims are properly presented, you should consult with an experienced health insurance accident lawyer. Your claim may appear simple at first, but minor blunders can jeopardize your ability to collect the funds required for your claim. Contact the Law Office of Doug Goyen at (972) 599 4100 to schedule a free initial consultation to discuss your case and how we can assist you.