Payment of Medical Bills FAQs

Colorado Personal Injury and Car Accident Attorneys

The other driver was at fault for the collision. Why doesn’t his insurance pay for my medical bills?

Colorado is a “fault” state, which means that the other driver must be found “at fault” in a civil case (not the traffic ticket) for him or his insurance company to have to pay your medical bills. This can take months, or even years. The driver’s insurance company does not pay for medical expenses as they are incurred (even though the adjuster hints that they might). You will be reimbursed for your medical expenses in only one lump sum settlement that includes all your claimed damages for personal injury. After you accept the settlement, you can’t go back to the driver’s insurance company and ask for more if you have more expenses in the future. This means that you can’t settle your auto injury claim until you are done treating for the injury.

Until you have completed your treatment and can make a settlement in your case, you must submit your medical bills to your health insurance company and to your auto insurance company (to activate your medical payments coverage). Making a medical payments claim will NOT increase your car insurance if the accident was not your fault. Remember, too, that there are time limits for submitting your medical expenses to your health insurance, so make sure that your medical providers are submitting all your medical expenses to your health insurance company. During the time of your recovery, you also need to keep track of all your out-of-pocket expenses (for deductibles, co-pays and non-covered expenses) so that you can make a claim for those items when it is time to resolve your claim.

Do I have to give my health insurance company all the details about the accident and the insurance company for the person who was at fault?

Yes. Even if you didn’t read your health insurance contract, you agreed in the contract to pay your health insurance company back, from any settlement you get with the liability insurance company, for the injury-related medical bills that they paid. Your health insurance company will send you a form that asks for basic information about the collision and injury, including who is the liability insurance company and the name of your attorney, if you have one. If you don’t cooperate with your health insurance company to give them this information, they could refuse to pay your medical bills until you do give them this information.

Your health insurance company will use this information to put the liability insurer on notice that it has a claim in your settlement.

Whether your health insurance company can make a claim for the entire amount they paid for your medical care from the injury depends on the kind of health insurance policy that you had. This is where knowledgeable and experienced attorneys can assist you in maximizing your settlement by minimizing or negotiating down the amount you have to pay your health insurance company from your settlement.

I am on Medicare. Will they pay for my medical bills?

Medicare is not “primary” to pay for your injury treatment if the injury was caused by the fault of another and that careless person has liability insurance. In such cases it is up to your medical provider as to whether Medicare is billed for your auto injury treatment.

The provider is required to pursue payment from the “primary” source, the liability insurer of the careless person, for 120 days following the date of treatment. At the end of the 120 day period, if the insurer has not made the payment, the provider may choose to bill Medicare (and get paid at the discounted Medicare rate) or choose to continue to wait for payment (at full price) from a future insurance settlement.

If the provider chooses to bill Medicare (and accept the discounted payment), the provider cannot also claim for the difference of the full charge from you or your insurance settlement.

When a provider bills Medicare, and Medicare pays the bill, then the Medicare Secondary Payer Recovery Contractor steps in and seeks to recover the Medicare payment from your insurance settlement. Knowledgeable and experienced attorneys know how to get Medicare involved in your claim from the very beginning so that its interest can be resolved as quickly as possible after your claim is settled.

I am on Medicaid. Will they pay for my medical bills?

Medicaid will pay for injury treatment from providers who accept Medicaid’s normal and customary discounted payment for medical services. Colorado Medicaid will then seek to recover those expenses paid from any insurance settlement you receive by notifying the insurance company that it has a “lien” interest on your settlement monies.

I don’t have health insurance. How are my medical expenses going to get paid?

Those who are injured by the carelessness of another, and have no health insurance for medical treatment, are in the most difficult situation. All your emergency medical care will be billed to you–at full rate, with no discounts that health insurance companies can get–and you will be required to pay for those expenses, even while you may not be able to work because of the auto injury. If you do not pay the medical bills, the ambulance and hospitals and doctors will quickly turn your account over to a collections agency, which may even file a collection action against you.

The worst approach is to ignore the bills. Before the bills are turned over to collections, contact the billing departments of the providers and work out a payment plan that you can live with until your auto injury claim can be settled. Sometimes medical providers will agree to accept a lien or an assignment of your account from your injury settlement.

If all this seems too much to handle while you are also trying to recover from your injury, it may be best to involve an attorney in your case. Experienced attorneys can often work with medical providers, or even collection agencies, to arrange for the medical providers to wait to get paid until after your claim can be settled. Attorneys also may know of medical providers who can treat you and who will agree to wait for your case to be settled for them to be paid.