Articles Posted in Medical Bills

Future Med Expense and Affordable Care Act
FUTURE MEDICAL EXPENSES

Future Medical Expenses and How Some Argue the Affordable Care Act Affects Their Calculation

Beware of Balance Billing

Beware of Balance Billing

Ed Smith is a Sacramento Personal Injury Lawyer. Health insurance is a complex topic, but most adults understand the basics of how the average policy is supposed to work. Suppose that Jorge goes to an “in-network” medical provider (meaning a medical provider with whom Jorge’s health insurer has agreed to certain contractual rates for services). Jorge receives services that total $700. He pays his $25 copay and goes on his way (assume Jorge has no deductible). The medical provider discounts Jorge’s medical bill to the rate it had agreed to with Jorge’s insurer, and then the insurer pays the provider the agreed upon rate.

Suppose further that Jorge goes to a medical provider that is not within his health insurance’s network of providers. The medical provider in this case can charge Jorge the full $700. Depending on the terms of the health insurance contract between Jorge and his insurer, the insurer may pay a portion of this bill. The medical provider would then bill Jorge for the balance that remains afterward. This practice is known as “balance billing.” Continue reading ›

health insurance in personal injury claimsAnyone who has had a visit in recent years to a hospital emergency room after a traumatic event — a traffic collision, slip-and-fall injury, dog bite — will likely have received a stack of forms from the hospital and from their health insurance company asking for details about the incident. Was another person responsible for the injury? Do you have an attorney representing you? Did you have any other applicable insurance for medical expenses, such as medical payments coverage on an auto insurance policy? Are you pursuing any claims against other people for these injuries?  Health insurance in personal injury claims has become a very complicated situation.

The hospital and the health insurance company aren’t doing this out of idle curiosity. They’re doing it because they want money out of any settlement or verdict relating to the injury incident. In the “old days” — 30 or 40 years ago — a person might get checked out in an emergency room after a car crash, the hospital would generate a bill that would go to the patient’s health insurance company, the health insurer would pay the hospital the reduced rate they’d previously agreed upon for these services, the hospital would waive or write off the difference, and the patient would never hear from the hospital billing department or health insurer again. If the injured person received a settlement from the auto insurer for the person who caused the accident, it was rare that the health insurance company or any medical provider who had accepted health insurance payments would ever show up asking for a piece of that settlement.