Articles Posted in Insurance

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What happens after you are in a car accident and are rushed by ambulance to a hospital for treatment?

There are 80,000 car wrecks each year in Dallas and Tarrant Counties — about 90 every hour — so this happens a lot here.

But the largest health insurance company in Texas, Blue Cross and Blue Shield, recently announced that its HMO members may have to pay for these super expensive ER bills themselves.

If BCBS concludes that the patient’s medical problem was not that serious to justify emergency attention, he or she will be stuck with payments that often exceed $10,000. No criteria or appeal process have been announced.

This draconian new policy begins on June 4th.

How is this fair?

How does someone know when his pain is so serious that it should be immediately treated or whether he should take a chance and just go home? Is he supposed to know enough medicine that he can diagnose himself and determine if he needs diagnostic testing to rule out a brain injury, herniated disc or heart attack?

This recording of a woman who called 911 in France complaining of pain and who soon died of a heart attack after being brushed off by a dispatcher is shocking — and could become the norm.

The new policy will affect 500,000 of the 5,000,000 Texans who have BCBS.

And a lot more of us, once the other health insurance companies start doing this with their HMOs and PPOs.

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11867031-stethoscope-on-money-dollar-cash-currency-banknote-background-using-for-healthy-financial-and-insuraBadly Needed Victory for Injured Texans.

The Texas Supreme Court has ruled in favor of an uninsured woman who challenged her whopping hospital bill of $11,000.

The opinion written by Debra Lehrmann, formerly a district court judge in Fort Worth, held that hospitals must disclose the lower rates that are given to people covered by health insurance or government assistance.

The case

Crystal Roberts was injured in a car wreck in Houston in 2015 and taken to North Cypress Medical Center. After x-rays, CT scans, and routine care she was discharged.

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Arbitration clauses have become the norm in health care provider contracts that patients must sign. Stranger

Why? They usually favor the big hospital over the little consumer and remove the possibility of a lawsuit.

But what happens when a patient is better off trying to resolve a billing dispute in front of a jury of his peers, not a panel of businessmen?

On Monday an all-too-rare appellate decision allowed that to happen when it sided with an injured Texan in Cardon v. Goldberg.

Why did hospital file a lien against patient’s settlement?

Susan Goldberg received treatment at the Seton Healthcare Services emergency room in Austin for injuries she sustained in an automobile collision. Ms. Goldberg incurred $7,800 in charges which were billed to her health insurer, Blue Cross Blue Shield of Texas. BCBS had the standard reduction contract with the hospital and the bill was reduced to $6,503.

BCBS agreed to pay its share of $4,600 and Ms. Goldberg was billed the remaining $1,903. She forwarded that to her own automobile insurance provider, Nationwide Mutual Insurance Company. So far, so good.

However, instead of just paying that lower amount, Nationwide somehow paid the full $5,000 available under her personal injury protection (PIP) policy.

You might think this situation could be easily corrected. After all, the hospital was paid in excess of the original bill, let alone the adjusted bill as negotiated by BCBS, and could simply refund the difference. Ms. Goldberg never agreed that all $5,000 of her PIP proceeds was to paid to the ER and had other medical bills and lost wages that she presumably wanted to pay with those funds.

But nothing is straightforward in the often Upside Down world of insurance (“Stranger Things” fans will quickly agree). Continue reading

dreamstime_s_60539434The National Highway Traffic Safety Administration (NHTSA) estimates that distracted driving costs $46 billion in economic losses and $129 billion in societal harm every year. It also cost 3,477 lives and about 391,000 injuries in 2015.

That’s a high price to pay. And if there’s a way not to pay, insurance companies will figure it out.

Distracted driving crashes have resulted in higher insurance premiums for everyone. This means you’ve borne the cost of other people’s texting. Unfair? You bet.

Allstate is looking at a different approach. Instead of jacking up everyone’s premiums, the insurance giant is charging texters more. Seems fair enough.

How does the company know you’ve been texting? And how does it know whether you’re posting that selfie while barreling down the highway? Like everything else, there’s an app for that. Here’s how it works.

Your smartphone has an accelerometer and a gyroscope that sense movement of the device. It can also tell whether you picked up the phone to glance at a text message or the phone was laying flat on the seat while the car was in motion.

The Allstate app utilizes these technologies to track whether you are using your phone while driving and your agent sets premiums accordingly.

Don’t worry, your insurance company can’t do this without your knowledge. You must first sign an agreement and download the app. Also, Texas Department of Insurance has to approve use of the technology first. Continue reading

Surprise balance bills can be a financial catastrophe.

dreamstime_s_5126046After 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:

  • Even if you are even covered by Blue Cross, not every hospital and doctor is your plan’s network,
  • Or you haven’t met your annual deductible yet, especially now at the beginning of the year,
  • Or you may have a large deductible, say $5,000.00, and never meet it each year,
  • Or the ambulance, hospital, doctor, or MRI facility refuses to file with the plan,
  • Or the hospital files a lien and demands payment in full from you and your recovery from the other driver,
  • Or the plan refuses to accept any claims, falsely claiming it is not required to do so,
  • Or the plan slowly pays some of the bills and then bills you for the enormous balance still due and/
  • Or the plan pays bills and demands subrogation (repayment) when you receive funds from the at-fault driver’s liability policy or another source.

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.

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Insurance adjusters are carefully trained to pay out injured people as little money as possible — if any. At the same time, they spend billions of dollars convincing you that they are your “good neighbor” (State Farm), “you are in good hands” (Allstate), or that “Liberty stands with you.” What nonsense.

These companies often use tricky, even sleazy, tactics to minimize claim and lawsuit amounts. That’s why you need a personal injury lawyer to fight for you.

How do you know when an insurance company is trying to cheat you? It’s easy. You’ll know it when you see that they

1. Pretend to be your friend. Don’t believe it. The adjusters are reading scripts and asking questions right off their computer screens. They will call back wanting to know if you are getting better but want to later be able to refer to the day you said you were feeling “better.” What they want to do is to gain your trust so you’ll accept a low settlement offer.

2. Pressure you to give them a recorded statement. Don’t even think about it. You are not legally required to. And anything you say can and will be used against you in settlement negotiations or at your trial, if one becomes necessary if and when they don’t offer you a good amount of money.

As soon as possible after the crash, the adjuster wants to  catch you off guard. You will probably be on pain medications, scared, and not had enough time to consult with an attorney. I’ve refused almost every

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simonsWhat are your options if you should be involved in a car or truck accident while driving to a sales meeting or making a delivery? Who pays to repair or total your car or truck and for your lost wages and medical bills? Your case can get complicated very quickly.

There are multiple sources you can pursue to collect compensation for your damages. In addition to filing on the at-fault driver’s or vehicle owner’s liability insurance policy and your automobile insurance benefits, should you consider filing on your company’s workers’ compensation policy?

How will workers’ compensation affect your claim?

You may have been told that you cannot file against or sue your employer for damages if you were injured on the job. You may be able to but it’s not always a good idea. Here’s why.

Workers’ compensation insurance covers your medical treatment and lost wages without you having to prove fault. In return for the guarantee of a substantially limited pay check, you waive your right to sue your company — even if it were negligent. But what if your service department failed to properly maintain the company truck’s brakes, causing you to crash and get seriously injured?

There are other drawbacks as well. You usually receive less quality medical care. Most “good” doctors refuse to file on “comp” since payments are drastically curtailed and the paperwork and red tape can be onerous.

Further, you will have to reimburse the money you receive for your lost wages and medical bills. This is a legal concept called subrogation authorized in the Texas Labor Code. That means that you will have to pay back the comp carrier for what it paid you up front. So if your net settlement proceeds are $20,000 but the comp company has already paid you $20,000, your “new money” will be zero. Not good, since your initial payments will have already been spent by you or paid to hospitals and doctors.

A good injury lawyer will fight to get that subrogation amount that you owe reduced. We are in the process of finalizing the severe injury case of the man pictured above who was driving his truck for his company when another vehicle failed to yield the right of way. He’s had three surgeries to date. We successfully obtained a huge cut of what he owed to comp after getting him the maximum available under the large insurance policy available.

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131209201711-03-weather-1209-horizontal-large-galleryWith freezing temperatures and wet roads forecast in North Texas, I was concerned this weekend would be particularly dangerous and it was. A toxic mixture of drunk drivers and slippery highways led to hundreds of car crashes.

170 auto accidents, including 26 rollovers, happened in Fort Worth on NYE before 9:00 PM — before prime drunk driving hours had even begun.

Later four people tragically died in these car accidents:

  • 12:33 AM – a wrong way driver crashed head-on into another vehicle on I-35 south of Dallas, killing both drivers.
  • 5:20 AM – a motorist died when a car he stole from a strip club caught fire after hitting a curb and crashed into a light pole on Irving Boulevard.
  • 5:25 AM -two good Samaritans stopped to help a driver who had collided with the median wall on LBJ Freeway. Another vehicle slammed into the accident scene, killing the driver and injuring one of the good Samaritans. The other good Samaritan, an off-duty Garland firefighter, escaped injury by jumping over the median when he saw the vehicle barreling down on them.

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IMG_854498% of cases settle out of court. In my 37 years of practicing personal injury law, I have never met any one who wanted to testify in a trial. My job is to get my client as much money as possible. Attempting to reach a favorable out of court settlement is often in his or her best interest.

After a thorough investigation and compilation of medical records, lost wages, and other documents, with the consent of my client, I often forward a complete demand package to the at-fault driver’s insurance company adjuster and attempt to negotiate a favorable out of court settlement.

The key to success is a well written demand letter. It’s a powerful tool that maximizes my client’s damages and has these distinct advantages:

  • It can resolve the claim in months — not up to the two or more years in can take to actually get to trial;
  • It saves thousands of dollars in additional legal fees, filing fees, court expenses, deposition fees, expert’s bills, and a host of other expenses; and
  • It avoids the anxiety of testifying and leaving the decision in the hands of 12 strangers who may rule against our side or even be biased against lawsuits or injury cases in general.

Of course I plan as if I’m going to be in trial, knowing that any case may not be successfully resolved.  And some cases must be filed in court immediately and others will never settle for as much money as I want my client to receive and suit is filed.

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Fiery-crashStudy finds hospitals charge people an outrageous 340% too much for ER care.

Johns Hopkins Medicine researchers have analyzed the records of over 12,000 emergency rooms in all 50 states and discovered that prices for the same procedures varied wildly between different hospitals. Rubbing more salt on the wound, the most vulnerable, least insured, and poorest patients were often charged the highest prices.

The researchers then compared the prices charged to the amount listed by Medicare. On average, patients were billed 340 percent more for their services than the Medicare listing price.

The researchers aptly referred to the practice as “price gouging.” This has got to stop. Car wrecks are not profit centers to support the rest of the hospital. Continue reading

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