Grizzlylaw | Who Should Pay? Part 2
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Who Should Pay? Part 2

Who Should Pay? Part 2

For the entire first part of this post, click here.  To summarize:  in a health insurance and medical provider vs. injured party situation, should the health insurance  pay before the auto insurance does? Or, should the medical provider be forced to accept the discounted health insurance reimbursement rates?

Enter the Montana Supreme Court.

There’s a slew of cases out there in Montana currently against medical providers for various issues relating to the Joe scenario. Cases alleging that the healthcare provider shouldn’t have: billed the auto insurance first, or refused to bill the health insurance companies, or returned the health insurance companies’ monies once medical provider found out that there is some auto insurance, or refused to accept only 80% reimbursement from the auto insurance when that’s all provider would have received if it had just billed the health insurance …

And, while we don’t have rulings on all these issues, the Montana Supreme Court, so far, ostensibly hasn’t wised up to what’s going on. Earlier this month, in<em> Harris v. St. Vincent Healthcare,</em> 2013 MT 207, the Court ruled that,where an injured party is also covered by health insurance, the medical providers don’t have to accept the health insurance reimbursement rates from the auto insurance.

In other words, the Montana Supreme Court said: healthcare providers, go ahead and bill and collect the full amount of your services to the auto insurance companies even where the injured party is covered by health insurance.

The optimist in me wants to think that the true nature of what’s going on was just successfully obfuscated by the technical contract terms the medical providers used. Because, in reality, the Court said  to all the Joes out there: “it’s not anybody’s problem but yours that you lost wages/will lose wages/need future medical treatment/have pain and suffering…Yes, it’ true that these auto insurance monies should make up for those things, too; but because of the adhesive health insurance contract, we will allow you to be run over by the medical providers and health insurance companies.”

p.s.  What happens to a Joe (where limits are higher) when both the insurance companies deny coverage: one arguing that particular services were NOT caused by the wreck (the auto insurance) and the other arguing that the particular services WERE caused by the wreck (the health insurance)? It’s hard to be an injured person these days, in more ways than one.

Rebecca J. Rutz
becky@grizzlylaw.com
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