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New Policy Refuses to Pay Bills For Patients Diagnosed with Non-emergency Condition

If you have been injured in a car accident in Fort Worth, how do you know whether your serious symptoms are a true "medical emergency?" You don’t. Only a doctor can know that, That's precisely the problem with the latest trend in health insurance that will deny payment of emergency room bills if the insurance company arbitrarily decides that your visit was not necessary. Effective on July 1st, this new rule was started by two of the largest companies, Blue Cross and Blue Shield and Anthem, in three states. You'll get stuck with a huge bill from the hospital, ER, radiologist, specialists, and ambulance. After many car crashes, these charges can quickly add up to well over $10,000.00. This unbelievable policy forces patients to immediately and correctly diagnose their injuries as they sit in their cars dazed or lie on the side of the road after a car wreck. They will have to weigh the risks of going to the emergency room versus waiting-and-hoping for the best. The repercussions of getting it wrong are enormous. What if they are have a broken bone, herniated disc, or brain bleed and don't know it? This is a serious problem for the victims of automobile wrecks -- and for every one else. You know that since this new policy will save the health insurance companies a ton of money, the other companies will adopt this infuriating idea and take it nationwide.

After a car wreck, you are often rushed by ambulance to an emergency room for immediate treatment.  Before the ambulance arrives or later as you lay in the ER bed, you assume that your Aetna or Blue Cross will pay for all of your bills, right? No, not necessarily. It's a complicated system that is extremely anti-patient for these reasons:
  • If your health insurance plan should decide to pay the bills, it usually files a lien and demands full reimbursement from your car wreck settlement or verdict.
  • Your hospital may be out of network,
  • Your Aetna plan may say that it is secondary to the at-fault driver's primary auto insurance policy and refuse to pay anything, and/or
  • You may not have met your annual deductible or have a large co-pay.
You won't know this until later. Much later. What happens then? You are stuck paying for $10,000 and often more of medical bills. You take it for granted that the other driver's insurance company will reimburse you in full, and still give you plenty of extra money for your lost wages, pain and suffering and other damages. Good luck if you don't have an experienced personal injury lawyer on your side. And to make matters worse, the emergency room department will also generate a separate bill which runs from $500 to $3,000 or more. This may also not get paid for the above reasons. The hospital will file a lien so they get paid in full -- or has the lien reduced by your attorney. Take a look at horrible story in today's paper about a Good Samaritan who just had a $151,000 hospital lien filed on her after she had to have her legs amputated. And a new bill has been approved by the Texas Senate that unfortunately allows emergency room physicians to also file a lien for their bills that must be paid from the proceeds and clarifies that any ER admission qualifies for the payment. SB 2066 will further reduce the amount of money an injured person will receive for his damages and I hope it does not get passed by the Texas House of Representatives and signed into law. But at least there's a little good news. State lawmakers just passed a bill that gives patients some recourse. The bill does not go as far as I would like but it is a good start to resolving this ludicrous system that hurts Texans. I urge Gov. Abbott to sign SB 507 so it becomes law.

A new law is closing down a deceptive billing practice that was costing seniors millions of dollars.  The NOTICE Act described in this revealing New York Times article requires hospitals to start telling seniors if they are not officially being "admitted" after 24 hours. Before this, a senior could be "observed" in the hospital and nursing home for days -- even months -- but not officially be admitted for Medicare purposes so they got stuck with huge medical bills. A personal injury lawyer represents many Medicare-eligible people (someone who is 65 or older, or is younger than that if he or she is disabled or who has certain diseases) after they are injured in collisions. How will the new law affect you?

My health insurance company isn't paying?! Getting crashed into is a bad enough experience -- made worse if  you can get slammed with enormous medical bills for your treatment. Our new clients often come to Berenson Injury Law with a small stack of past due statements and letters from bill collectors. Bills can sometimes reach hundreds of thousands of dollars. Problems arise when your health insurance company doesn't cover all of these bills. This is a difficult problem for personal injury lawyers to contend with. What can you do to protect yourself?

With sincere slogans like you're in good hands and you can rely on us, commercials for insurance companies make them sound like they are your best friends.

But they are businesses whose primary purposes are to make money. How do they do that? By denying or minimizing payments on claims. 

That's why you'd be smart to hire a good personal injury lawyer to explain how the often complicated automobile accident process works before you pick up the phone after your wreck.


If you have collision coverage, personal injury protection, or have to file on your own uninsured motorists benefits because the at-fault driver is not insured or you were involved in a hit and run, you must notify your insurance company. 

And if you know which insurance company the at-fault driver is covered by, you want to immediately call them to demand they pay your medical bills, fix or total your car, and get you a rental car.

They will routinely ask that you give them a recorded statement. But you don't have to give one to the other driver's company, and you should not give one to your own company right away. 

In Texas, the standard insurance policy only requires that you promptly notify your own company, and there is no time deadline on advising the other driver's carrier. You are likely to feel anxious and be in pain, and possibly affected by painkillers prescribed to treat your pain.

After a car wreck, mounting medical bills and lost income will cause you financial hardship and stress. So you may be enticed by the quick settlement offer the other driver's insurance adjuster promises if you cooperate with him. But relying on him will slash the financial recovery you are entitled to. Just say no. Call a good personal injury lawyer instead.

Insurance Companies Are Businesses, Not Friends

Remember, an insurance company is never your "good neighbor" and you are not "in good hands" with one. Just the opposite, it is a business that has only one objective: maximizing its profit. 

The biggest cost to an insurance company is payments made by adverse claimants or its own policyholders. The adjuster is a highly trained employee who has every incentive to reduce these payments as much as possible.

Chances are high that you will at some point be involved in a collision with an uninsured motorist in Texas. According to the Texas Department of Transportation, 20 percent of all vehicles in the state are uninsured -- but in my experience as a personal injury lawyer, it seems like way more. There are far too many people who only make their first payment on their liability policies and let them lapse. 

Texas Laws Governing Auto Insurance 

Every driver in Texas must carry the mandatory minimum of auto insurance. Driving without insurance could result in up to $350.00 in traffic fines, and up to $1,000.00 in fines and a two years driver's license suspension for repeat offenders. An uninsured driver who is also unlicensed faces up to $2,000.00 in fines and 180 days in jail. In addition, an uninsured motorist who causes a car accident that results in serious injuries or deaths could be sentenced to incarceration and steep fines. 

To comply with the law, a driver's vehicle must be covered by 30/60/25, which is:

  • $30,000 for each injured person in a single accident
  • $60,000 for all occupants injured in a single accident
  • $25,000 for property damage per accident
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