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

Depositphotos_2633699_s-2019

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

Liens: Why Is There a Lien in My Case?

LIENS: What, Who and How Liens Affect an Injury Case

THIS ARTICLE DISCUSSES:

  • What Is a Lien?
  • Who Can Take a Lien?
  • How Is My Case Affected by a Lien?
  • How Can Burman Law Help Reduce or Eliminate a Lien?

What is a Lien?

In a personal injury case, a lien is defined as “any official claim or charge against property or funds for payment of a debt or an amount owed for services rendered.”  A “lien” is like a debt you owe, but instead of paying the debt with your own money, you pay that debt using your personal injury settlement money.

To help understand, here is a common example.  Let’s say a careless semi-truck driver runs into your vehicle, sending you to the hospital.  You have no idea who insures the semi-truck driver, so your health insurance pays the hospital bills caused by the truck driver’s negligence.   The hospital submits a bill to your health insurance carrier and your health insurance carrier pays it, less any deductible, etc.  Now, here is how the lien arises: when your health insurance carrier pays the hospital bill, your health insurance carrier has a legal right to obtain reimbursement for the money it paid to the hospital for your medical bills.  This legal right to collect money creates a “lien” in favor of your health insurance carrier.  The lien goes against the settlement you eventually receive from the trucking company’s insurance carrier.  The dollar amount of this lien is equal to the dollar amount paid by your health insurance carrier on the hospital bills associated with your wreck injuries.

There are other legal terms you may hear when a lien is discussed.  “Subrogation” means “stand in the shoes of.”  “Reimbursement” means to “collect what has already been paid.”  When another party, such as the health insurance carrier in our example, has subrogation or reimbursement rights against your personal injury case, then the health insurance carrier stands in your shoes and holds the right to place a lien against the compensation you receive from your personal injury case.  The health insurance carrier holds certain legal rights to reimbursement for what it paid.  When the health insurance carrier has a lien, it is commonly called a “lienholder.”

Who Can Take a Lien?

We used health insurance in the above example.   A health insurance carrier is probably the most common entity to assert a lien, but there are many other types of liens in a personal injury case.  Let’s discuss a few other common types of liens.

One type of lien occurs when there is a Letter of Protection (LOP).  Although emergency departments must legally provide you treatment, other non-emergency health care providers may refuse treatment unless you provide an (LOP) from your attorney. An LOP is a signed agreement between you and your health care provider which guarantees payment when your personal injury case is concluded, either by settlement or jury award.

Federal law allows Medicare and Medicaid to place a lien on your settlement. These types of liens are administered by the Centers for Medicare and Medicaid Services (CMS) and under contracts with some private administrators. Federal law gives Medicare and Medicaid liens precedence over any other lien.  This means that federal law allows Medicare and Medicaid Services to jump in front of everybody, including the injured party, and get paid before any other lienholder receives payment.

In some states, including Tennessee, a common lien we see is called a “med-pay” lien.  It arises when you contracted for medical payment coverage with your automobile insurance carrier and you submitted medical bills to your insurance company for payment. When your automobile insurance carrier pays, it will frequently inform you that it will be asserting a  lien against your settlement seeking reimbursement for the bills it paid.

In Tennessee, hospitals can hold a lien under Tennesse law.  This type of lien is called a “hospital lien.”

So, you can see that various types of liens can arise under the facts of a particular case and the federal or state law that applies to the lien.

How Is My Personal Injury Case Affected by a Lien?

Let’s recap the types of liens we have discussed:

  • Health insurance liens
  • LOP liens
  • Medicare liens
  • Medicaid liens
  • Med-Pay liens
  • Hospital liens

Liens and lienholders can affect a case in a number of important ways.  First, a lien can significantly reduce the amount of compensation available to you for your injuries.  Secondly, a lienholder can intervene in a case and create delays and uncertainty when you want to resolve your case.  Thirdly, a lien placed on your personal injury settlement can affect your ability to maintain control over the settlement funds.  And lastly, in extreme cases, a lien can affect your ability to secure future medical treatment under your health insurance coverage.

How Can Burman Law Help Reduce or Eliminate a Lien

The number one thing we do at Burman Law to help reduce or eliminate a lien, is to start early and be “pro-active” with liens and lienholders.  At the beginning of each case, we gather the facts relevant to each lien and lienholder.  We establish contacts with decison-makers.  We read the contracts that discuss the lien, identifying weaknesses and developing legal strategies to reduce the lien.  We communicate with lienholders and take a stand on your behalf.

In every case, we can reduce the lien.  In most cases, the reduction is significant.  In some cases, we obtain a very substantial reduction or eliminate the lien entirely.

For years, we have studied liens and lienholders.  We understand where weaknesses can be found, and where the law is on your side.   We keep you informed about any existing liens and make sure you are not surprised at settlement time by suddenly discovering there is a lien.

We also make sure to document the full dollar amount of all your losses in any settlement demand or closing argument.   When we resolve your case, we are always careful to take into account liens and lienholders so you are protected from future claims by the lienholder.  We are pro-active to ensure your settlement or award is not delayed by “last-minute” snafus.

If you have questions about how liens work in personal injury cases, or any question about your personal injury claim, contact Mike Burman for a free consultation.   In addition, Mike Burman never charges to consult with lawyers in other cases about how to reduce or eliminate liens.

Sources

https://dictionary.law.com/Default.aspx?selected=1160
https://www.law.cornell.edu/uscode/text/42/1395y
https://www.bizfilings.com/toolkit/research-topics/running-your-business/asset-strategies/different-lien-types-provide-creditors-with-different-rights
https://www.injuryclaimcoach.com/bodily-injury-claim-settlement.html