“The insurance company said they’d pay all my medical bills. Now they only want to pay a fraction of what I owe!’
We have heard this complaint almost daily in our decades of practice.
What’s the reason and who’s the culprit? Of course, every story like this begins with the fact that car insurance companies are designed to collect premiums and not pay out. But that is not the only conspiracy happening here.
Hospitals and medical providers have found ways to use the car insurance system to increase profits, as well. In a recent article in The New York Times, the master plan of hospital billing is broken down into the following steps:
1. Medical Swag
When you are in a wreck, the first thing the EMS or ER staff will do is slap on that age-old neck brace. Often, that neck brace either came free as medical sales swag or was bought in bulk at a rate of a few bucks each. When you get your medical bills in the mail, you find out that your insurance paid $100-plus and you owe an additional $20 bucks or so after insurance. You could get the same brace at your local pharmacy for much less. But when your chart is flagged for a car accident, out comes the medical swag. And in the end, all of this gets paid by the car insurance company… out of your settlement.
2. The Cover Charge
When you are taken to the emergency room, you get a bill. That we know. But did you know that this bill is just for use of the room? In essence, that bill is a “cover charge” for entry. In addition to that fee, which may vary depending on how emergent or traumatic your injury may be, there is a separate fee for every material used and every person who walks into the room. In many cases, you’ll even get a completely separate bill just for the use of a doctor, a necessary component of your emergency room visit. This bill, again, may vary based on what the hospital determines is the severity of your injury. Two guesses what they label car accident victims as in order to increase their bill.
3. Impostor Billing
Not only can you get billed for every person who walks in the room, but you may also receive a bill for people who you have never met. Medical billing allows for “consult billing,” even when the physician never consulted with the patient themselves. If a radiologist simply stops an orthopedist in the hallway for a second look at your x-rays, you get billed. These are not common charges, but we see them often in cases like auto accidents where the hospital anticipates deep pockets.
4. The Drive-By
In more serious cases, where post-ER treatment is required, you can get billed even before your first visit. For instance, if your injury requires physical therapy, a therapist can enter the room just to discuss your future therapy visits, and you will receive a bill for that conversation. A full assessment or actual therapeutic treatment is not required for the hospital to bill for it.
We have added this prong because it is so prevalent and crushing to your in-pocket compensation while filling the hospital’s bank account. Hospitals allow representatives from Avectus or other lien companies to enter patients’ rooms, although they have no medical training or degrees and have not received consent from the patient or relatives. Their only purpose is to have medicated and shocked accident victims sign forms promising to pay the hospital’s bill in its entirety, regardless of whether they have health insurance. Why? Because the hospital does not want to take the contractual discount with the health insurance, and instead wants to take as much as possible from the auto insurance policy, in addition to all of your other medical bills.
The End Game
Why do we care so much about what the hospital is doing if the car insurance company is paying in the end? Why should you care about what money goes where?
An auto insurance policy is like a bank account. Everything that comes out of it – including medical bills – reduces the amount in the account. In other words, every penny the hospital takes is one less for you. If your hospital bill is inflated simply because you were in an auto accident, your compensation for the injuries you sustained will go to the hospital rather than to you. If the auto policy available is only $50,000 and your hospital bill is $40,000, there is very little money left to pay remaining bills, reimburse your lost wages, or cover your future medical needs. And that’s if you don’t come out with a $75,000 bill and only $50,000 in automobile insurance.
What can be done to stop this? Short of changing legislation, simply put, you need an attorney. Our office has decades of experience forcing hospitals to use health insurance and refusing to pay their liens if they are on notice and ignore us. We not only fight the insurance company on your behalf, but we also hold the hospitals to a high ethical and economical standard, refusing to let them dig into the policy that was meant to compensate you.
Be aware and proactive with your health and your future. Work with a firm that has no blind side. We see the attacks coming, and will head them off at the start.