by jesa » Tue Feb 17, 2009 06:36 pm
Should I pay out of my own pocket to maximize my settlement offer or should I just let the third party insurance cover my medical bills. I was just in an auto accident last week. I have had one ER visit and a few chiro visits. I have sprained my neck. My car was totaled but it is an older car. Damages were well over $8000 to the car. There is no dispute that this was not my fault but I don't want to be at a disadvantage if I let the third party pay. I think it's not too late to have the ER and the chiro not send the claim to the third party. Please let me know if you think it matters if I pay or if the third party pays regarding my settlement offer. I'm in Texas.
Posted: Tue Feb 17, 2009 11:24 pm Post Subject:
An offer is not made on _unpaid_ bills alone. They will need to know the full cost fo all related medical expenses for consideration. it won't change anything if they are paid or not.
But I think you misunderstand how it works. The other carrier won't pay dime one until there is a _settlement_. Once you have both agreed on an amount to settle the claim, then they can either pay the remaining bills and/or pay you directly.
Posted: Wed Feb 18, 2009 07:35 am Post Subject:
How exactly you want to maximize the claim? Is it by paying the bills first and then inflating those to gain maximum from the insurer?
Lemme tell you that would be considered as fraud. And most likely the insurer won't blindly payout what you have demanded. They will evaluate the worth of the claim before releasing the money to you.
You may need to elucidate what you meant by 'maximizing settlement'.
Thanks,
Rupert
Posted: Wed Feb 18, 2009 05:31 pm Post Subject:
TCOPE, thanks for the info. Let me clarify a bit. I went into the ER and the chiro with a claim number for the accident (from the third party insurance) and left without having to pay anything. I felt good that I didn't have to pay out of pocket – what worries me is can the 3rd party say they don't want to pay for all the bills and then I'm stuck with the difference 2-3 months from now? I don't understand how this works because I have not talked to a medical adjuster. I've only talked to a “repairs adjuster” and now a “total loss” adjuster. I talked to the chiro yesterday and didn't realize that he won't get paid till this whole thing gets settled.
Rupert W Bradson - Fraud would be deception like lying to the insurance company in order to gain a higher settlement. I have the right to a settlement since this accident happened with no fault of my own and it has obviously caused some damage to me, my car, and my personal life. By maximizing my claim I mean that I want the insurance to pay for the full amount of my med. bills - then compensate me for my lost wages, pain and suffering etc. I've been told that I can be offered a lump sum that may not even cover the total amount of my medical bills and I would be left with nothing for my time off work etc. And, since I haven't seen a single ER bill or chiro bill I'm wondering can I afford to even go?
Posted: Wed Feb 18, 2009 05:37 pm Post Subject:
One more quick note to clarify. Part of what started my worrying was I read online that when you let the third party pay for your bills they are in control of your medical treatment and can access your medical history vs. me paying out to pocket, with my health insurance or with PIP.
Posted: Wed Feb 18, 2009 06:04 pm Post Subject:
Part of what started my worrying was I read online that when you let the third party pay for your bills they are in control of your medical treatment and can access your medical history vs. me paying out to pocket, with my health insurance or with PIP.
not true as to them being in control of your treatment...they will require at some point a medical information authorization, so they can get doc/hospital reports etc...prior to offering you a settlement...do you have health ins? medpay or pip on your auto policy?Posted: Wed Feb 18, 2009 06:19 pm Post Subject:
yes I have all of those - however concerning my health insurance I am currently on a self health policy with a high deductible I'm about to switch health insurance companies with a new employer in just a few weeks. is this a pre-exisitng???? this was the WORST time for me to be in an accident :(
Posted: Wed Feb 18, 2009 06:27 pm Post Subject:
however concerning my health insurance I am currently on a self health policy with a high deductible I'm about to switch health insurance companies with a new employer in just a few weeks. is this a pre-exisitng????
most likely...this was the WORST time for me to be in an accident
as opposed to three months from now which would be a 'great' time? :wink: i'm just teasin' you...i know what you mean , but trust me there is NEVER a good time...ok you have PIP so PIP will handle all of your med bills, you will have to eclipsed the pip threshold to have a bi claim against the other carrier anyway (TX must be a pip/no fault state)...also will use your medpay as well so the bills can be paid as you go, then your carrier (if allowed) will subro the at fault carrier for repayment...be sure you have filed this PIP/medpay claim with your carrier.Posted: Wed Feb 18, 2009 06:39 pm Post Subject:
The other carrier will not be paying the bills on an ongoing bases and you will probably receive those medical bills in the mail from the provider.
Basically, the other carrier will make an offer to settle your _entire_ medical claim. They will require that you sign a release so this _one_ payment is for _everything_, past present and future. If the injury is minor and it's possible to know what the future medical bills will probably be, the carrier may make an initial offer. Its up to you if you want to accept it or wait. If no one knows how much will be spent on medical bills, then the process will need to wait until you are close to being done with treatment. If this takes 6 months or a year... that is how long it takes. Nothing is paid by the other carrier in the meantime.
The medical providers have every right to require _you_ to pay your medical bills. Your dealings with the other carrier are between the carrier and you. However, all providers know that people rely on insurance money to pay the medical bills and if they did not treat anyone who could not pay up front, they would be out of business. So they may send threatening letters but as long as you let them know the situation, they will usually wait for settlement. Also, they can always send a medical lien to the carrier. This means that the insurance company is required to pay them the amount owed when they pay you. That way the medical provide knows they will get paid.
The insurance company is only responsible to consider reasonable and customary charges. But a Property and Casualty carrier is less likely to review the amounts being charged like a health carrier is going to. So I don't think that will be an issue. However, they will look to see of they feel the person was over treating. If the medical records indicate a minor sprain and the person treats at a chiropractor's office for 3 months, 4 times a week, then they may present this as an issue.
Basically, they should look at all the medical expenses and then add an amount on top of that in an effort to reach a settlement.
If the insurance company pays you directly for the medical bills so that you are responsible for paying the providers, you can also speak to the providers to see if they might be willing to lower their bills. In some cases, they will lower then 30%-50%. Any amount would mean more money in your pocket. The carrier can't ask a provider to lower their bills... as they are not the carriers bills so they don't have any grounds for asking.
Posted: Wed Feb 18, 2009 07:46 pm Post Subject:
Thanks all this info is very helpful. There's way tooo much info on the net that's just confusing me!
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