Some Medical Bills Can Now Be Cut

Medical bills payment can be a huge problem after a vehicle collision

After you have been in a car or truck crash, you may have been rushed by ambulance to an emergency room. Expensive medical treatment and tests were performed. Worrying about how these medical bills were going to be paid was probably the last thing on your mind. So you will be shocked to find out later that you owe a huge sum of money for your medical bills. This happens often.

Berenson Injury Law has been representing injured Texans for the past 40 years and this can be one of the biggest hassles of the car/truck crash process.

We see one or more of these happening:

  • Objections and delays are made by health insurance companies and medical professionals to avoid paying medical bills;
  • The hospital or medical providers may be out-of-network; or
  • The deductible, copayment, or coinsurance rate is not paid; or
  • The patient is required to repay the medical bills later from his settlement or jury verdict.

If this sounds familiar, that is because you were not told any of this at the hospital or by your doctors. You may not find out until months later when you open your mail and see “surprise bills” which can be $10,000 or more. You naturally assumed that the other driver’s insurance company or your health insurance plan would have paid these by now.

The medical bills morass is unfortunately a common problem after a car wreck, especially here in Texas. A recent study showed that we had almost the highest number of these out-of-network charges in the U.S.

If you have health insurance, you probably do not know which hospitals and doctors (other than your PCP) are in-network. You will have no idea what medical procedures cost. Before this happens to you, you should study your plan’s directory and research costs so you will be prepared.

What can you do to reduce your medical bills?

Tips for how to deal with surprise bills:

  1. Do not pay them. Try to negotiate this complicated process yourself. Or
  2. Hire the best personal injury lawyer you can find. He or she can explain the ramifications of the car crash procedure and medical billing scenarios. Make sure that they will also negotiate down bills that may be owed due to hospital liens, health insurance liens, and sums claimed by medical professional as part of their legal services. Check their reviews to see if past clients have mentioned this free service and if they are highly pleased with the attorney’s services.

New law is a start towards patient protection

Senate Bill 1264 was passed during the last legislative session. It took effect on September 1st and affects medical services provided after January 1st. The law only affects Texans who are covered by state-regulated health plans (government employees and teachers).

There are new limits placed on medical providers who are out-of-network and try to balance bill. For the first time, these providers cannot bill for money in an amount more than the applicable copay or deductible. This amount will be based on the first amount determined that was owed or modified after an appeal (see below).

However, if the non-emergency medical service gave the patient certain notice, it is exempted from this cap. We are monitoring this notice to see if it is given to our clients who qualify.

The new law also requires that a dispute resolution process be set up when the health plan and medical provider disagree on the amount of the payment. They must have a teleconference within 30 days and must attend mediation or arbitration if necessary.

Analysis of new law

There are severe problems and shortcomings. First and foremost, it does not apply to most people who have self-funded employer-sponsored health plans or Medicare. This law needs to be expanded to all Texans.

Second, the patients can waive the balance billing protections when they have a choice between using an out-of-network or in-network provider, unless there is an emergency or the out-of-network doctor is assigned to the patient’s care later, e.g. a radiologist or anesthesiologist is added to the surgery.

Third, the out-of-network provider can claim it gave the patient notice the required 10 days in advance of the day of service if the provider intends to bill the consumer rather than request mediation or arbitration.

Non-emergency providers are required to give patients written notice in advance of certain important facts including the amount for which the patient may be responsible

The law survived a last-minute lobbying effort by the powerful Texas Medical Association which wanted to water it down even further.

12 Ways to get your medical bills paid

Our team is here to help you through every step of what can be an arduous journey, especially when it comes time to getting your bills paid.

One and probably more of these 12 options will be available:

  1. At-fault driver’s/his company’s (if a commercial vehicle is involved) liability policy
  2. Health insurance plan
  3. Letters of protection (guarantees to medical providers that they will be paid from the final proceeds so that our clients don’t have to pay up front), then we negotiate down the bills.
  4. Personal injury protection benefits (PIP) – if they were purchased by the driver or owner of the vehicle you were in. These can pay $2,500 or more per injured person. We have a new case where our client is from out of state and has $20,000 available. The company must send us proof that the insured rejected coverage in writing; we got our two clients $5,000 last week when the company failed to produce this proof after claiming our clients had rejected coverage.
  5. Medical payments – related to PIP coverage, they must be purchased by the insured driver but then have to be repaid. We fight to reduce this repayment balance and have lowered several reimbursement amounts in the last month. 
  6. Uninsured (UM) – if the at-fault driver has no insurance.
  7. Underinsured (UIM) – if the at-fault driver has an insufficient amount of insurance. Here is an example: the injured person has surgery to his or her back. The at-fault driver only carries the standard liability policy in the amount of $30,000 per person. Medical bills are $30,000. Lost wages and other damages add to the claim. We have settled several substantial UIM cases recently.
  8. Medicare
  9. Medicaid
  10. Workers compensation or quasi-WC plans
  11. Short-term and long-term disability insurance
  12. Installment agreements – our office will help our clients make payments (without charging interest) if all other means fail.

Each method has its pros and cons. And it is important which ones are used and in which order. The resolution of this important topic will greatly affect how much money you end up receiving at the conclusion of your case.

A good car accident lawyer can explain how you should proceed.

Please call or email our office if you have any questions. We are here to fight to get you the compensation you deserve.

For more information on this topic:

Medical bills mediation requests stun Texas officials


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