After being in a car accident, you smartly checked your health insurance policy and only went to an in-network hospital and doctor so that you would only have to pay a small copay. They assured you at the front desk that they would bill your Aetna plan.
Then a few weeks later you may have started screaming when you opened the mail and read whopping medical bills for thousands of dollars. It happens every day to people who are injured in collisions in Fort Worth and North Texas. Medical bills cause a staggering 643,000 Americans to file bankruptcy each year.
Here’s what causes enormous medical bills to happen:
This financial roulette is a catastrophe. Medical bills can be astronomical even if health insurance steps up and pays the bills in full. This process is unfair to Texans for so many reasons and must be reformed.
You can’t guarantee that every medical provider you saw and will see is in your network.The ambulance that showed up at the scene drove you to the nearest available hospital. By sheer luck, the ambulance and hospital might have been in-network, but the separate company’s emergency room doctor often is not. Even if you knew this (which isn’t likely unless you searched your plan documents first) you weren’t exactly in a position to demand to be transferred to a different hospital that was in-network. It’s a dangerous game of financial roulette and it can be ruinous to your bank account.
Why does it matter if the hospital is out of network? Because it will charge whatever it wants, many times higher than the negotiated insurance rate of your in-network one. So a $1,000.00 bill that should have only been $200.00 in the first place can be billed at $5,000.00 or more.
Guess who pays the difference — you. That is, unless you hire a good personal injury lawyer.
I regularly negotiate for the maximum possible damages as well as getting the lowest possible reductions for the medical bills of my clients. Success on both of these fronts is crucial for a successful outcome. After all, it doesn’t matter if you get more money from the other driver’s insurance policy if you have to hand all of your proceeds to hospitals and doctors. This is especially true if you had health insurance and should have been covered to begin with.
I have negotiated with insurance companies and medical providers for the past 37 years and am often shocked at what they charge, e.g. $3,000.00 for MRIs.
Here are some of the steps I take to help my clients on a daily basis:
Fortunately Texas law now offers some relief to this balance bill nightmare. For the first time in our state’s history beginning this past September, a person now has right to request a mediation between the insurance company, doctor, himself, and his car accident lawyer to negotiate bills of $500.00 or more. Before that, a highly restricted process allowed arbitration and then lawsuits on a limited number of claims.
Also starting a few weeks ago on January 1st, this right was expanded to include all of those new stand-alone clinics like CareNow where a simple visit can easily cost over $1,000.00. Starting on September 1st. they were finally required to post a list of which health insurance plans they (supposedly) did file on. The Fort Worth Star Telegram described how these free-standing ERs sometimes charge 10 times more than standard rates and how they “blind side unsuspecting consumers.”
The practice of balance billing is common in Texas. But 2,064 patients have heard of this new procedure and insurance companies agreed to pay $1.1 million and health care providers agreed to write off more than $6 million in bills last year.
These surprise bills must be avoided from the outset of your injury case. Once filed, the providers will first try to collect the bill themselves, then send them out to a collection agency which will ruin your credit. They will even sue you and take a judgment plus attorney’s fees, court costs, and interest that will be in your credit file for the rest of your life,
If you have been in a car wreck, I can discuss how this complicated process works during a free consultation.