Can I use my health insurance for a car accident injuries
If you have been injured in a car accident, using your health insurance to seek medical care is advisable. In some cases, you may find the doctor you are trying to see won’t take your health insurance if they find out you have been injured in a car accident. They might try and make you pay out of pocket for your medical expenses.
One reason they might do this is because doctor’s have contracts with the health insurance companies. When they see a patient that has Aetna, Aetna and the doctor have already reached an agreement as to what Aetna will pay for the service rendered. In some cases, this can be 40-65% of the actual medical bill. When you have a personal injury case, the doctor will not want to take your health insurance. Furthermore, he may feel he can get more money from you than the health insurance company.
In most situations, Health Insurance will not cover car accident injuries. In some cases, you can make use of PIP or Med Pay to ensure that your medical bills are paid.
Does your health insurance plan cover your injuries after an accident?
There are a few reasons why you might not be able to use your health insurance after a car accident, depending on your situation and insurance policies. Here are the common reasons
1. Primary Coverage by Auto Insurance (PIP or Med Pay)
In many states, Personal Injury Protection (PIP) or Medical Payments (Med Pay) coverage is part of your auto insurance policy and is required to be used before your health insurance kicks in. These types of coverage are often primary, meaning they take precedence over health insurance when it comes to paying for medical expenses from a car accident. If you have PIP or Med Pay, your health insurance may not cover medical bills until these benefits are exhausted.
Med Pay or Medical Payments
Medical payments are designed to pay for medical care or visits to the doctor. This coverage is for you and anyone in your car. It doesn’t matter who was at fault for the car wreck. This coverage will allow you to see a doctor and use whatever treatments are necessary. The dollar amount is set by you, the policy holder. Med pay will pay out up to the dollar amount you set if your injury requires it. Even if your health insurance will pay for car wreck injuries, you still should have Med Pay coverage. It can be used as the primary and then secondary. It is easier for a doctor to bill than health insurance, so it’s a great advantage to health insurance in the event of a car accident.
Med Pay usually comes in increments of thousands of dollars. This amount is per person, not per accident. If you have 4 people in your car, the amount will be the same for each person, you are not thrown in a pot, and everyone gets to divide it.
PIP: Personal Injury Protection
The one thing that you can use immediately when you are hurt in a car accident. For those that don’t know what PIP stands for, it is personal injury protection insurance. When you look at what PIP really is, you will notice that this is quite like health insurance plans. The only difference is that you can only claim for injuries sustained in an accident. This includes you and anyone in your car, no matter if you were at fault or not.
In some states, it is a must that every driver has a PIP insurance policy. However, there are some states that don’t see this as a necessity. Pip can be helpful when you are in a car accident and sustain a lot of injuries that are going to cost a lot of money. The most common difference between PIP and health insurance is that the doctor who accepts pip will do all the paperwork for you. Many Healthcare providers will not file for Pip or med pay. They consider this third party billing. And most PCP’s or primary care doctors will not file third party claims.
States that require Pip
- Delaware
- Florida
- Hawaii
- Kansas
- Kentucky
- Massachusetts
- Michigan
- Minnesota
- New Jersey
- New York
- North Dakota
- Oregon
- Pennsylvania
- Utah
Ask your doctor if you reside in a PIP state about what to do after a accident and who the primary will be. They will be able to guide you through the process of filing a pip claim if you have need help doing so.
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- Can I use my health insurance for a car accident injuries
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2. Coordination of Benefits (COB) Rules
Health insurance policies often include rules for coordination of benefits, which dictate which insurance should pay first. In the case of car accidents, your health insurer may require that your auto insurance, or the at-fault party’s insurance, pay for your medical expenses first. Only after those benefits are used might your health insurance cover remaining costs, if at all.
3. Exclusions in Your Health Insurance Policy
Some health insurance policies include specific exclusions for injuries resulting from car accidents, especially if you live in a state where PIP or Med Pay is mandatory. The policy may state that it will not cover medical expenses for a car accident if another insurance type is supposed to provide coverage first.
4. Subrogation Clauses
If you do use your health insurance after a car accident, it’s possible that your insurer has a subrogation clause. This means that if you receive a settlement from the at-fault party’s auto insurance, your health insurer may seek reimbursement for any medical bills they paid related to the accident.
5. Pending Liability Determination
If there’s uncertainty about who is at fault for the accident, health insurers may delay paying for your medical expenses until the at-fault party’s insurance coverage is determined. This can temporarily prevent you from using your health insurance for accident-related treatment.
6. Network and Coverage Limitations
In some cases, health insurance might not cover certain treatments or providers that are necessary after an accident, particularly if the treatment is outside of your insurance network.
What you can do when health insurance won’t pay for car accident injuries
1.Find a Doctor on Accident Doctor
Accident doctor has thousands of doctors listed around the country that treat auto accident injuries. And even if we don’t have one listed in your area, we will find you one. We do have some patients that live in remote areas, we do our best to find you a doctor that is close and will treat your car wreck injuries.
2.Ask if the doctor will file third party car insurance
Ask your doctor or health care professionals if they will file third party. Depends on the state in which you reside, but in my opinion, it is rare to find a medical doctor that will bill third party insurance. However, third party billing is very friendly in some states, such as Virginia.
3.File Personal Injury Protection
If you live in a PIP state, PIP becomes your primary insurance in the event of a car accident. Pip will cover most anything that can happen to you in an auto accident. However, pip has limits, and if you require surgery or have extensive hospital stays, pip will run out fast. Some states such as in NY, it is easy to find a specialist that will accept pip. However: in other states, such as FL, it might be harder to find a personal injury doctor that will just accept pip without going through a third party such as a chiropractor.
4.File a Med Pay Claim
Medical payments are in a nutshell, health insurance in the event of a car accident. Just like PIP, it could run out if you have a serious injury. I personally carry 10k in med pay; this is more than enough to cover a soft tissue injury. But if I had a broken bone or required surgery, I would be in trouble. So, I’m going to call my agent and bump my coverage up to 50k. The difference in the policy amount after 10k is smaller than you think. The more you buy the less the premium goes up.
In my personal experience where a client had an extensive injury (required back surgery). Med pay was the primary coverage, when it ran out; Health insurance took over the burden. This tends to happen with more serious injuries. Health insurance may cover serious injuries that require surgery or hospital overnight stays.
5.Speak with your attorney
Attorneys know that when they have a client that has been involved in an auto accident, medical care will be an issue. Depending on the injuries sustained, will depend on how the attorney can help you. Most, not all attorneys have relationships with doctors in their area that will treat auto accident injuries.
These doctors more than likely will treat on a medical, or attorney’s lien. Sometimes attorneys are a necessary evil. I don’t hold a very high opinion of most personal injury attorneys; however, I believe there are some out there who genuinely want to help others in need. If you need an attorney after a car accident and don’t know who to speak with, contact us.
Tips to remember when claiming for a car accident injury
No matter if you are claiming from PIP or from your health coverage. These tips are some of the things that you should remember when you are claiming for a car accident injury:
• Make sure that you know what your PIP or Med Pay coverage is covering during an accident, and if you have a PIP or Medical payments coverage.
• When your claim is denied by the health insurance company, don’t panic. It is common for health coverage to deny auto accident injuries.
• If you don’t have a health insurance, Med Pay is something that you should seriously consider. It can help cover all your medical expenses when you are in a car accident.
If you have health insurance, try and use it
After your car wreck, you may take a trip to the ER. If you take a trip to the ER, you might ride in an ambulance. Use your health insurance. The ambulance service or ER doesn’t care if you have a personal injury case. All they care about is getting paid. If you don’t turn the bill over to insurance, it might be quite some time before it gets paid. If too much time has passed, it might get turned over to collections. Your credit could suffer.