Medical bill and health insurance form with calculator

MEDICAL BILLS: The Who, What, When and How After a Personal Injury

THIS ARTICLE DISCUSSES MEDICAL BILLS CAUSED BY PERSONAL INJURIES:

  • Who is responsible for payment?
  • What to expect?
  • When is payment due?
  • How are medical bills satisfied so my credit is not affected?

Every personal injury that causes physical pain leaves you with medical bills.  Payment is always a major concern.  Payment problems can destroy your credit, or worse, cause bankruptcy.  This article gives you the “big picture.”

Who Is Responsible for Payment?

The short answer is simple: you are primarily responsible to pay your medical bills until your health care provider receives payment.  So, the first step is to determine who you can hold legally responsible for payment of your medical bills.  If you have health insurance of some kind, then you must contend with high deductible payments and within the fine print of your health insurance contract are subrogation and reimbursement clauses that allow your health insurance carrier to make a claim against your personal injury recovery, but that is the subject of another article on case liens.

Who you can hold responsible for your medical bills depends on the type of case you have.  Does the case involve a motor vehicle such as a semi-truck and trailer, a work truck, or a personal family automobile?  Did the injury occur on public or private property?  Was the injury caused by a professional, such as a doctor?  Even cases involving marine and inland waterways have different ways to determine who ultimately is responsible for payment of your medical bills.

What to Expect?

Let’s look at a few different types of cases.  This will give you the “big picture”  on what to expect.  We will discuss “primary” and “secondary” responsibility for payment of medical bills.  Primary means “first in line” to pay your medical bills.  Secondary means “next in line” to pay your medical bills.  In some injury cases, three or more different entities may be”in line” to pay your medical bills.

Motor Vehicle Collision Injuries:   In Kentucky, motor vehicle injuries are first paid by the insurance carrier of the automobile in which you were injured.  This is called Personal Injury Protection Coverage, or PIP for short.  PIP coverage is usually capped at $10,000 unless more coverage was purchased.  After PIP pays, your personal health insurance pays.  If you do not have health insurance coverage, then you must make arrangements to pay your medical bills out of personal funds, or make arrangements to settle your personal injury case with the at-fault party so you have funds to pay your medical bills.  Burman Law takes care of this settlement process for you.  Tennessee injuries are handled differently.  Tennessee law does not require PIP coverage.  You can voluntarily purchase medical payment coverage but you are not required to do so.  If you do not have medical payments coverage, then your personal health insurance pays.  If you do not have health insurance coverage, then you must make arrangements to pay your medical bills out of personal funds, or make arrangements to settle your personal injury case with the at-fault party so you have funds to pay your medical bills.  Again, Burman Law takes care of this settlement process for you.

Work-Related Injuries:  In Kentucky and Tennessee, there is an administrative process that requires you to give notice of a work injury to your employer, and then your employer connects you to an insurance adjuster who pays the medical bills related to your work injury.

Slips and Falls:  In Kentucky and Tennessee if you slip and fall on public or private property due to negligence, then the owner of the property turns your medical bills over to the property owner’s business insurance.  Some business insurance policies provide for immediate payment of $1,000 or $5,000 for medical bills.

Dog Bites:  In Kentucky and Tennessee, dog bite injuries are paid by the dog’s owner, who may or may not have insurance.

Nursing Home and Child Care:  In Kentucky and Tennessee, nursing home and child care injuries are paid by the owner’s business insurance.  Some business insurance policies provide for immediate payment of $1,000 or $5,000 for medical bills.

Malpractice Cases:  In Kentucky and Tennessee, malpractice claims are paid by the professional’s malpractice insurance.

When Is Payment Due?  

When you receive medical services, you make a contract with that medical provider for payment.  It is up to you to determine who has responsibility for payment.  Find out from your medical provider when payment is due, or contact Burman Law for assistance.  We help all our clients determine the best Plan of Action for the payment of medical bills.

How Are Medical Bills Satisfied So My Credit Is Not Affected?

You must be pro-active.  You cannot wait until the last minute.  Satisfying your medical bills is a process in every personal injury case.  At Burman Law, our client portal allows you to easily upload a medical bill to us so we can review it and develop a Plan of Action.  Your good credit is important.  Protect it with the experience Burman Law provides.  We do not charge one penny extra to handle your medical bill credit issues, that is all part of our fee agreement with you.

Contact Burman Law for Assistance

At Burman Law, our 25+ years of experience gives you someone on your side when a bill collector calls.   Whether you are facing the collection of medical bills in Kentucky or Tennessee, we have straight answers and practical solutions for every situation.  Contact Mike Burman for a free consultation.

Sources

http://insurance.ky.gov/PPC/static_info.aspx?static_id=24&Div_id=15
https://www.alllaw.com/articles/nolo/auto-accident/no-fault-insurance-claim-work.html

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What to do When Your Health Insurance Refuses to Pay

Health insurance companies often deny pre-authorization requests for testing or medical treatment. Sometimes, the company refuses to pay the medical bill after you have already received the services. You feel punched in the gut when you receive a bill, sometimes for hundreds of dollars, with a note from the care provider that your insurance denied your claim.

Many times, the denial seems unfair. You may feel trapped and assume there is nothing you can do, but if this has happened to you, you do have some options. You can appeal the denial, but the first step is to understand why the claim was denied.

Reasons the Insurance Company May Give for Denying Your Claim

  • The claim was not covered under your health insurance plan. Read your policy carefully. You may be interpreting a clause differently than the insurer is interpreting it. Contact your insurance company and ask for a detailed explanation of its denial. You need to understand this in order to pursue an appeal.
  • The service was not “Medically Necessary.” You will need to get your health care provider to explain, in writing, to the insurance company why the service was medically necessary if already performed, or is medically necessary so that your insurer will commit to covering the procedure.
  • The service is, or was at the time it was performed, experimental or investigative.
  • You failed to get preauthorization for the service. Most insurance plans now require healthcare providers to get preauthorization before they provide certain medical or surgical services. Discuss this with your physician.
  • Another insurance policy is responsible for the claim. If you have two insurance plans, for example, you and your spouse are both covered through your work, one plan may be expected to pay first. This is also true if the healthcare services provided to you were the result of a car accident, the insurer for the at-fault driver may be expected to pay your bill.
  • You received care from an out-of-network provider. If this was due to an emergency, you need to provide this information to your insurance company.
  • There is an error somewhere in the process. For example, a billing error may have occurred, such as the wrong code used by the medical biller.

If your claim was denied for any of these reasons, or because you were told simply the service was not covered, you have the right to an internal appeal.

How to File an Appeal

Call your insurance company. Have them explain to you in detail why your claim was denied. Also, ask them to explain to you how to file an appeal. Follow the appeal instructions precisely.

Write an appeal letter. This is the most important part of your appeal. The purpose is to convince the company that it should pay your claim. Your letter should include:

  • A brief description of your medical condition including why the service was, or needs to be, performed.
  • Reference the portion of the insurance policy that you believe says the service is covered. Use specific language from the policy indicating the service should be paid for.
  • Attach a statement from your healthcare provider who performed or ordered the service that explains why the procedure is medically necessary, or if it was already performed, why there was no time for preauthorization.
  • Wait a few days, then call and verify the company received your appeal documents.
  • Follow up as much as necessary.

Be sure you keep a file documenting everything you have done. Any time you have a conversation with an insurance representative, document the date and time of the call, who you spoke with, and a summary of your conversation. If you are told to call back because the person you need to talk to is away, note the date and time of your call and the reason you were given to call back.

If your internal appeal is denied, you can then contact your state’s insurance commissioner and request an external appeal. The National Association of Insurance Commissioners maintains a list of all state commissioners and information about how to contact them.

Contact us for Help

Depending on the amount of money involved, you may decide to do this appeal yourself. If a large amount of money is involved, or you just feel you need help with the process, contact us at Burman Law. Our slogan is “Mike Will Fight to Make it Right.”

 

Sources

https://yourgpsdoc.com/2017/06/11/how-to-file-appeal-insurance/
https://www.verywellhealth.com/health-insurance-company-wont-pay-323174
https://www.medicalbillingandcodingonline.com/medical-billing-errors/
https://www.naic.org/documents/members_membershiplist.pdf

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THE CORONAVIRUS SHUTDOWN – Advice for Personal Injury Clients

THIS ARTICLE PROVIDES ADVICE FOR CLIENTS FACING:                                                          

  • Prescription Medication Shortage
  • Unavailable Medical Provider
  • Lost Income
  • Extraordinary Harms and Losses
  • Other Related Matters

PRESCRIPTION MEDICATION SHORTAGE   

  1.  If you have access to a pharmacy, then stock up and buy extra medication.  Talk to your pharmacist to determine what is a reasonable amount of medication for your future needs.
  2.  If you do not have access to a pharmacy or prescription, contact your past medical providers and request a prescription.  If all else fails, an ER doctor must treat you.

UNAVAILABLE MEDICAL PROVIDER

  1.  If your current medical provider is unavailable, contact your past medical providers and request substitute treatment.
  2.  Some health care insurance plans provide off-site treatment via telemedicine providers.  See Other Related Matters below for more information.
  3.  If all else fails, an ER doctor must treat you.
  4.  At Burman Law, we are working to develop a list of alternative treatment providers.  We will do our best to find someone to see you.

LOST INCOME

  1.  If you earn wages and lose your job, file an unemployment claim.  Contact Burman Law if you need help with your unemployment claim.  On any unemployment questionnaire that asks about what you can and cannot do, answer by indicating you are “ready, willing and able to work within any restrictions set by your medical provider.”
  2. The Trump administration is requesting two rounds of $1,000 stimulus checks to adults, plus an additional $500 for each child.    More will be posted on this as the legislation develops.  Checks are planned for April 6.

EXTRAORDINARY HARMS AND LOSSES

  1. Kentucky and Tennessee law recognizes harms and losses can increase due to complications caused by economic or medical issues traceable to the injury.
  2. Document, document, document – by date and short description – how your harms and losses increased because you could not get medication, receive treatment or suffered increase stress when your employer raised your job duties beyond your work restrictions for example.

OTHER RELATED MATTERS

Burman Law is here to assist as this shutdown touches each of us.  My legal team may not have every answer, but we have years of experience and contacts to solve your problems.  Contact us.

Please use the Burman Law Client Portal as much as you can.

We are keeping a list of alternate medical providers who may provide you with a short-term solution.  Contact us for more information.  Here is a list for Hopkinsville and Clarksville medical providers who have told us they will try and help:

Jennie Stuart Medical Group 270-886-7427 112 Keeton Drive Hopkinsville, KY 42240.  Call ahead and the Doctor will evaluate by phone if need to come in or do a Telehealth Visit
Premier Medical Group 931-245-7029 490 Dunlop Lane Clarksville, TN 37043.  Stated at this time still taking appointments as usual, but please use precaution and wash hands.

Some health care insurance plans cover telemedicine. Telemedicine is the diagnosis and treatment of patients by means of telecommunications technology. You can obtain an answer by contacting your health insurance provider via telephone or by their website.
i. Blue Cross Blue Shield of Kentucky – 859-226-5300
ii. Blue Cross Blue Shield of Tennessee – 423-535-5600

Here are additional numbers and links for more information:

TN Department of Education COVID-19 629-888-5898 or toll free 833-947-2115- hotline is available Monday-Friday 6:30 a.m.- 4:30 p.m., email [email protected]

TN Department of Health- Tennessee Coronavirus Public Information Line- hotline 877-857-2945

https://www.tn.gov/education/health-and-safety/update-on-coronavirus.html

Pennyroyal Center RESPOND hotline (available 24/7/365): 877-473-7766

Kentucky’s COVID-19 Website and hotline: 800-722-5725, or general inquires can be emailed to [email protected]

Be aware that gaps in treatment with no reasonable explanation are hurtful to any case.  Document gaps in treatment by date and a short explanation for the delay.  Send us Progress Reports.  We routinely keep insurance adjusters updated on your case, even in this pandemic, we are sending update letters to the adjusters.

My staff and I have years of experience dealing with injury-related matters.  We have never experienced a pandemic, but we are familiar with catastrophic loss.  As we learn things, we will update this post.

God Bless You and America.  We will win this fight together, and we are working remotely and at the Hopkinsville office if you need us.  The Clarksville Office is not open to the public.