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Who Should Pay? Part 1

It’s a touchy subject to those in the healthcare industry. It’s a touchy subject to those injured in car wrecks and other accidents where liability insurance is available. It’s something not well understood by the general public – or, apparently, the Montana Supreme Court.

“It” being the subject of who should pay when a person in a wreck is covered by health insurance.

Here’s a pretty regular premise: Joe, a concrete laborer, is hurt real bad in a car wreck. Joe goes to the emergency room after the wreck. Doctor after that.   Physical therapist and chiropractor after that.

Now it’s looking like Joe might need surgery. All because of the wreck (although the auto insurance disputes that the physical therapy and chiropractor visits were actually from the wreck).

Joe has health insurance. Also, Joe can’t work because of the wreck.

So, who should pay for the medical bills? Auto or health insurance?

At first blush, it may seem that the medical providers should bill the auto insurance. Why not, right?

Well, the at-fault driver’s auto insurance only carried the minimum $25,000 limits. So, by the time we factor in the past lost wages and future lost wages … those limits should really be used to make up for Joe’s other damages. And, Joe didn’t take my advice to carry UIM. So, that’s it, $25,000.

Does it still seem like the health care providers should bill the auto insurance? I don’t think so. Why should the vast majority of the auto insurance money go to the medical providers when they could be paid for the services by the health insurance? Joe’s got past lost wages. Future lost wages. Future medical expenses. Not to mention pain and suffering.

He was the one hurt in the wreck, shouldn’t some (most!) of this money go into his own pocket to compensate him directly? Are we really going to tell Joe to just cowboy up here, lie down and take this?

For those who love to look for a conspiracy, let me add that the health insurance companies generally only reimburse 80% of the total billed services by medical providers. And, the health insurance companies are currently re-writing their policies so that medical providers must bill auto insurance first …  It’s a win-win as far as some medical providers and the health insurance companies are concerned: health insurance collects a premium and doesn’t have to pay claims and medical providers get 100% on the dollar instead of a reduced rate.

Multiply that by thousands and it adds up to real savings.

About the Author

Rebecca RutzRebecca “Becky” Henning-Rutz graduated from the University of Montana with her law degree in 2006 and has been working in Kalispell ever since. Becky has been working as an associate for Henning, Keedy & Lee since 2007.View all posts by Rebecca Rutz →

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