It's not unusual for health insurance companies to attempt to recoup some of the money paid for medical care provided to accident victims through a process called subrogation. Unfortunately, medical professionals are taking a page out of those companies' book and chasing after accident settlements using a method called balance billing. Here's what you need to know about this issue so you can be prepared to fight against it.
Balance Billing Explained
When doctors and other healthcare providers agree to be part of an insurance company's network, they also agree to accept the rates the company is willing to pay them. In almost all cases, these rates are less than what the medical professional normally charges. In an effort to get more money for their services, some medical professionals will bill the patients for the difference between the insurance providers' discounted rates and what they normally charge if they know the patients are likely to be involved in personal injury lawsuits.
They attempt to get this money by either billing the patients directly or submitting claims for payment against the responsible party's insurance policy. For instance, if a doctor knows the patient will be getting money from a third-party's auto insurance company, he or she may submit a balance bill to the insurance company as well.
In either case, this practice can negatively impact your personal injury case or settlement because it can lead to you receiving less money than you would have if the medical professional had not interfered.
Preventing Balance Billing
Some states ban balance billing outright or in certain contexts, so it becomes a non-issue depending on where you live and/or seek care for your injuries. California prohibits emergency room doctors from billing patients for the portion of their fees not paid for by patients' health plans, for instance. Those doctors must resolve billing issues with the insurance companies.
Your plan provider may also restrict medical professionals from balance billing. For instance, healthcare professionals who accept payments from Medicare and Medicaid are prohibited from engaging in this practice with people who use this insurance. Therefore, read your plan contract to determine if this is the case and reject any bills the provider may send.
Avoid signing anything from a medical professional that stipulates you will pay the person's full fee. Some healthcare providers will make patients sign documents stating they will pay the full amount the professional normally charges before providing the patient with care. These contracts essentially create binding agreements that can be enforced in court. If your healthcare provider tries to make you sign this type of contract, go somewhere else for medical assistance if possible.
There are other things you can do to prevent balance billing or mitigate its impact on your personal injury lawsuit. Contact a personal injury lawyer for assistance with this issue.