Articles Posted in Insurance

Health insurance company medical bills

A health insurance company must pay medical bills, right? No, not always.

We are often hired by people justifiably angry after their Blue Cross-Blue Shield plan declined to pay for their amulance, hospital, and doctor bills. You have to pay expensive premiums and high deductibles and co-pays. So it is natural to assume that after you are in a car or truck collision in North Texas, that your health insurance company will pay for your medical bills. But unfortunately, it often won’t. But you won’t know this for months.

So the best thing for you to do after being in a wreck is to hire a good personal injury lawyer immediately. He will fight to get your medical bills paid or lowered by your health insurance company and your damages paid by the other driver’s liability insurance company. And if you don’t have health insurance, he can get you treated by qualified doctors and pay for some of them up front or guarantee payment so they are repaid from your insurance settlement or jury verdict. It’s a win-win for you.

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New decision is a rare victory for plaintiffs

If you are injured in a crash caused by someone driving while intoxicated, file a lawsuit, and receive a punitive damages award from a jury, will you be paid? A surprising federal court ruling from the country’s most conservative federal appellate court of the 13 circuits decisively answered that question.

Background: Carlos Sanchez got drunk at a bar in San Antonio, ran a red light, and slammed into this car driven by Richard Frederking in 2004. Sanchez pled guilty to DWI.

If you have been in a car crash, you need to understand that the auto claims process is designed to cheat you. Insurance companies use tactics designed to keep you from getting your damages paid back for car repair, medical bills, lost wages, pain, and other items. This includes not just the other driver’s  insurance company but your own if you have purchased collision, rental car, personal injury protection, medical payments, uninsured motorist, and underinsured motorist benefits. This post will explain what you can do to protect your rights and make more money.

Auto Claims

Insurance companies are obviously in business to make as much money as possible. They make less profits if they pay out substantial amounts in claims. So an  adjuster looks for ways to save his company money.

Even if he seems friendly, he is trained to use often abusive tactics that guarantee that he (or a jury if you take your case to trial) pays less than what a claimant deserves. Smart people know this and seek immediate help from a personal injury specialist.

Southlake man learns how astronomical air ambulance bill can be

A helicopter flying a critically injured patient to a hospital can save his life, but when he finds out what the air ambulance bill is, he might have a heart attack. The average cost for the ride is now over $40,000. A med evac invoice is the poster child of our skyrocketing health care costs.

On Monday an article in the Dallas Morning News showed how enormous a bill can be. A young doctor in Southlake was severely injured and was rushed by ground ambulance to a local hospital in Wichita Falls. He had to be immediately flown 100 miles to John Peter Smith Hospital in Fort Worth, the closest level one trauma center.

Sadly, after eight operations, the doctor had to have his arm amputated. A few days later as he was recovering in the hospital, he received the first of many demanding calls from the company wanting him to pay a stunning $56,603. Yes, you read that correctly.

The doctor’s health insurance company only paid about $12,000 — and only after being forced to do so since the ambulance company was out-of-network with his Blue Cross Blue Shield plan. Right after his crash, he was obviously not in a condition to verify whether the ambulance company was in-network and demand a different helicopter.

Most of these companies choose not to be in-network. If they are, they refuse to bill health insurance plans, instead billing the patient for the full amount. Or sometimes they bill Aetna or Blue Cross, which pays what it considers to be the reasonable cost of the ride. The patient is stuck with the balance, like here. The helicopter company then hires aggressive bill collectors and attorneys to file lawsuits when the exorbitant expense is not paid in full. Medical bills are the leading cause for people to file bankruptcies that ruin their credit.

The man still owed a shocking balance of $44,631. This is in addition to other inflated hospital and doctor bills he has to pay. This is a serious problem for many people after they are in a car or truck collision.

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Getting injured in an automobile or truck crash can be very expensive. When you are rushed by an ambulance to an ER, have x-rays and/or or MRI’s performed, and go to doctor’s and physical therapist’s appointments, the car accident medical bills can quickly add up to thousands of dollars. You may not be able to work.

Car Accident Medical Bills

Getting your medical expenses paid can be one of most difficult and frustrating parts of being in a wreck.

Why? Although you might assume that State Farm is going to start paying your bills, the opposite is true. The other driver’s insurance company does not want you to get the medical treatment you need so it doesn’t have to pay for it.

So a friendly representative will often make vague promises to someone not represented by a lawyer, only to delay and even deny his or her claim. The injured person won’t think he needs to hire a lawyer and will then be forced to accept a low-ball offer —  and still have to pay back a stack of bills.

Read Top 10 ways insurance companies trick you after you are in a car accident.

If the company should decide to pay you, it won’t ever pay your bills right away. Texas law does not impose any deadlines and you can be sure that State Farm is not in a hurry to write you a check before it has to.

In the meantime, you need help. How can you get the medical treatment you need and pay for it?

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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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Badly 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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An arbitration clause is the new normal in health care provider contracts that patients must sign. Why? They usually favor the big hospital over the little consumer and remove the possibility of a lawsuit.

arbitration clause

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).

Stranger Things

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The 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.

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:

  • 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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