A doctor in a white lab coat holds his hands and a stethoscope behind his back.

Medical Providers Not Accepting Health Insurance After An Accident?

Is Your Doctor Refusing to Bill Your Health Insurance?

It appears that not only are you going to have to deal with the accident and the injury itself, but now you have to deal with medical bills and individual providers that have refused to bill your health insurance company and are looking for payment from you. As an accident attorney in our area, we see this all the time. Accident victims are telling us that their doctor, physical therapist or other medical providers will not accept their health insurance because they were injured in a “car accident.” The providers are seeking to gain access to their car insurance.

If you have encountered this situation, we recommend that you first immediately contact an attorney, because your life has just become more difficult, and then you want to make sure to double check that the provider is an approved provider by your health insurance company and that they are an “in-network” provider.

Providers and Health Insurance Contracts After an Accident

If that is the case, they have agreed to accept your health insurance under contract, and they are required through that contract to bill your health insurance company. (You might need to respectfully remind the provider of that!) However, if they are not an “in-network” provider, you might need to switch to one that is. Keep in mind that in an emergency situation, you may end up seeing someone that is not under contract with your insurance company and so dealing with their billing office may become difficult.

The West Virginia Board of Medicine has issued some opinions on this issue. They have outlined explicitly that if you have been a patient of a healthcare provider in the past, and they have billed your insurance for those visits, it is potentially a violation of the West Virginia Medical Practice Act, and a doctor could be sanctioned by the board. The Board also looks down on the requirement of “Letters of Protection” for doctors who have existing relationships with patients.

The Miley Legal Group takes pride in building relationships with local medical providers. We understand that they have a job to do, and they should be compensated for that work. However, we also want to ensure that they are paid fairly and under the contracts that they have entered into with the various health insurance companies that operate in our state.

Why would my medical provider prefer my car insurance to pay my bills rather than my health insurance company?
In the end, it could all be about the money for the provider. There is a general belief that providers will be paid more under a car insurance policy than that of a health insurance policy, and that is correct.

Under a health insurance policy, they are limited to the amount that they will receive for specific services, based on the contract that they signed with the health insurance company. The auto insurance policies do not have those limits, and so they can bill a higher rate. Unfortunately for the patient, if the auto insurance pays the provider directly, that reduces the amount that is available for the patient to claim for themselves. It also reduces the amount that is available to other providers, and if you are facing a minimum limit policy, that can cause some problems.

I want my provider to get paid so who cares whether it comes from the health insurance company or the auto insurance policy?

Well, that question is reasonable. But keep in mind that each health insurance policy is different, and depending on how the bills are paid, your financial position could change.

Assuming you have to reimburse your health insurance company, (which you may not, it depends on your policy and an attorney can help you with this) you want to be in the best position possible to do so. Some issues can come up if your medical bills are not processed through your health insurance company including:

  • Credit Issues – Car accident claims can take a long time to prepare. You do not want to mess up your credit score because it takes up to two years to get your medical bills paid. I guarantee the provider is not going to wait that long to get paid. Processing your claim through your health insurance company will get the request paid quicker and possibly avoid collection agencies.
  • Reduced Settlement– In the end, it may not be all about the money for everyone, but you need to understand that if the health insurance company pays the medical bills, they will require the provider to take a reduced rate which becomes relevant when they are looking to be reimbursed during your settlement. So you can pay your bills at a 100% rate through the car insurance, or refund your health insurance at a lower percentage, leaving more money in your pocket.
  • Bills May Not get Paid– If for some reason the provider does not bill your insurance company or waits to file a claim after your settlement, more than likely they will not get paid. Most contracts between providers and insurance companies require that they submit a claim within six months to a year from the date you saw the doctor. (Some insurance policies have an even shorter window.) And if they miss that time frame, they will never receive a dime from your health insurance company. This is very important for those cases that take a long time or in the situations where the liability for the accident is not apparent.

In the end, we want your medical providers to be paid, and we know that you do as well. There are sometimes during your recovery that you may encounter a provider that makes your life more difficult. We will do everything in our power to make sure the process is smooth and that you not only get the care you need but that the provider taking care of you gets the payment they deserve for that treatment.

Author Bio

Tim Miley is the Founder of Miley Legal Accident Injury Lawyers, a West Virginia personal injury law firm he formed in 2006. With more than 30 years of experience in personal injury law, he is dedicated to representing clients in a wide range of personal injury cases, including car accidents, trucking accidents, motorcycle accidents, brain injuries, wrongful death, and other personal injury matters.

Tim received his Juris Doctor from Duquesne University and is a member of the West Virginia State Bar and the Harrison County Bar Association. He has helped his clients win more than $10 million in personal injury verdicts and settlements and has further served the people of West Virginia by filling legislative roles in the state’s government since 2004.

LinkedIn | State Bar Association | Avvo | Google