Who pays your medical bills after an accident — your health insurance, or the car insurance of the guy who hit you?

The Other Guy’s Car Insurance Ultimately Pays Your Medical Bills . . . But Not Till the End of the Claim. Car Accident Cases Are Not Pay As You Go Claims

The answer, like every good lawyer-answer, is: It depends. Ultimately, if the guy who hit you is at fault, his car insurance will pay your medical bills. But the more pressing question is not “who” pays the bills, but rather “when” are they paid? The payment system in car accidents is that the other guy’s car insurance will pay your bills; but only at the end of the case. In the meantime, your health insurance — if you have it — picks up the tab.

That is why it is a great benefit to have health insurance if you are injured in an auto accident and require medical treatment. That way, you can get your bills paid while you are waiting for the settlement or judgment to come through in your favor. Many people feel it is unfair that their own health insurance pay their medical bills for treatment from an accident. That is understandable. If the other driver is at fault, then it is only fair that the other driver’s auto insurance pay their bills. And justice is generally served. The other guy’s car insurance will pay for your medical care, but only after you are done treating and the case is finished.

When Is the Claim Finally Over?

The case is finished when you have finished treating and/or your doctor tells you that you have recovered as much as you possibly can. The advantage of having health insurance in an accident situation is that you have the ability to pay for treatment as it is needed. Additionally, insurance companies love documentation. They want to see records of your injuries and bills supporting your treatment.  In fact, an insurance company will not pay out at all on your claim unless you are treated for your injuries; the medical records and bills for the treatment provide evidence of the injury.

Unlike Workers Compensation, which is a pay-as-you-go system. A car accident is a pay-at-the-end system. When you are injured while on the job, and have a Workers Compensation case, your employer’s insurance will pay for your treatment as it is needed. You do not have use your own health insurance.

The “Whipsaw” That Happens When You Are Injured in an Accident Without Health Insurance

What happens to a person injured in an auto accident without health insurance? This person is put into an unfortunate “whipsaw” situation. If you are injured, you need treatment, but if you have no health insurance it is hard to get treatment. Additionally, the other driver’s car insurance company, as previously mentioned, will not pay a claim unless there is a record of medical treatment and bills. That is why it is important for a person without health insurance, who is injured in an accident, to talk to an attorney. An attorney may be able to recommend medical providers who will treat a person without health insurance, and will be willing to put a lien on the insurance settlement. Unfortunately, such providers have become fewer with the advent of the consolidation of medical providers.

The Benefit of the “Contractual Adjustment”

There is an additional benefit to having health insurance when injured in an auto accident– namely, the “contractual adjustment.” Health insurance allows a medical provider to write off or contractually adjust the amount billed for a particular medical service. Health insurance companies are able to negotiate contractual discounts due to their large size. An example of this is an MRI test; it is charged at $5,000. The health insurance company contractually adjusts that charge to $1000. The third party insurance (auto insurance) will pay the full amount of that charge of $5,000. Because your health insurance was able to adjust that charge to $1,000, you will only have to pay back your health insurance company $1,000 from your settlement (because you cannot be paid twice for a medical bill). Furthermore, once your case is settled, often your health insurance company will accept a discount on the amount of bills that they initially paid and that you have to repay from the settlement.

Please, Protect Yourself and Your Family By Having Some Kind of Health Coverage

It is much better to have health insurance if you are injured in an auto accident as you have the means to pay for your treatment as you are treated as well as the potential for keeping more of your settlement money for yourself. People without health insurance do not have the advantage of contractual adjustments on their side, and often times must pay out more of their insurance settlements to their medical providers.