Why Won’t the Hospital Charge My Health Insurance if I’m in a Car Accident? 

Consider this scenario: You’re in a car accident in Rhode Island. Stopped at a red light, the driver behind you looks down to read a text, doesn’t realize the light has turned red, and crashes into your car. Badly hurt, you are rushed to the hospital suffering a number of injuries from the rear-end impact, including whiplash, a serious face abrasion, and a dislocated shoulder. The texting driver is clearly at fault for the crash and given a citation for distracted driving, according to the police report obtained by your Rhode Island Car Accident Attorney David Tapalian. After a week in the hospital, you are released but regular doctor visits and twice-weekly physical therapy sessions for your shoulder and neck injuries are required. In the meantime, you are unable to work at your regular job which requires heavy lifting, but thankful for the health insurance coverage your employer provides its workers.

Fast forward a month, you receive a bill for thousands of dollars from the local hospital where you received emergency medical care after the crash. This must be a mistake- you have health insurance! You ignore the bill but it keeps appearing in your mailbox month after month. During this time, you continue to visit the doctor and attend physical therapy sessions on a regular basis. Your car accident lawyer is working diligently on your Rhode Island car accident claim, negotiating a settlement with the at-fault drivers’ insurance company who has admitted fault for its insured’s negligence. Your facial injury has healed, your neck and shoulder mobility show improvement, and you’re hopeful the doctor will clear you for light-duty work soon. Looking forward to moving on from this chaotic time in your life, you plan to catch up on your rent payments once your personal injury claim is settled and you receive the compensation from your car accident settlement from Attorney Tapalian.

Stunned, therefore, is the only way to describe how you feel when you receive a notice in the mail informing you a hospital lien has been placed on your pending car accident settlement due to your unpaid hospital bills. How could this be possible? You have health insurance! Why are you receiving the bill and why didn’t the hospital just bill your health insurance carrier? According to Attorney Tapalian, unfortunately this is a situation that occurs all too often with Rhode Island car accident claims and it’s a real problem. It happens with car accident settlements in Rhode Island and in many other states. After treating an injured car accident patient, instead of billing the patient’s own health coverage, whether private health insurance, Medicare, or Medicaid, the hospital bills the patient directly. If the patient doesn’t pay up, which in most cases isn’t even financially possible for the injured person to do, the hospital may place a lien on the patient’s compensation from a potential car accident settlement claim, per RI General Laws § 9-3-4. The hospital lien requires the hospital be paid prior to the patient/client receiving any money from their settlement.

For example, Joe Smith expects to receive $30,000 from his Rhode Island car crash settlement. However, a hospital lien exists for $20,000 in unpaid hospital bills from the crash. The $20,000 hospital lien must be paid first leaving Joe Smith with only a third of the money he was originally awarded in the RI auto accident settlement.

How Does the Hospital Benefit?

Why would a hospital bill a patient, instead of billing the patient’s health insurance coverage? The main reason is financial. Health insurance carriers typically have contracts with hospitals which result in lower profits for the hospital. If the hospital can charge more, and get paid more, by bypassing the insurance provider, they make more money. According to a recent New York Times article, this is a concern that often affects lower-income patients and wealthier hospitals. Case in point, Medicaid may pay the hospital $2,500 for a particular expense, but if the hospital can charge full-price instead of billing Medicaid, they can instead make over $12,000 for the same expense.

Perhaps the most troubling part is that the hospital is actually able to do this because, according to unclear and outdated laws, the hospital is not required to bill the patient’s own health coverage first. Unfortunately, the hospital is able to take advantage of the average person who isn’t aware of this practice and isn’t aware they can seek help and advice from a lawyer. A scenario like this can be extremely detrimental to a person’s financial situation, negatively impact their credit score, and cause great distress.

Over the years, some states have updated their hospital lien laws, thereby requiring a hospital to bill a patient’s own private health coverage, Medicare, or Medicaid, first. However, many states still have yet to do so, making it allowable for the hospitals to continue this worrying practice.

What to Do When You Receive a Bill from the Hospital After Your Rhode Island Car Accident

If you’ve been in a motor vehicle collision and you are receiving bills from the hospital that should be covered by your health insurance plan, you’re likely wondering how to get your insurance provider to pay your hospital bills. There are a number of actions you can take; but firstly, it’s important to note that you should not ignore these bills. This holds true even if you can’t understand why the hospital is sending them to you, instead of your insurance provider.

If the hospital bills go unpaid after a certain amount of time, even if they should be covered by your insurance, the hospital may place a lien on your pending car accident settlement case in Rhode Island. A hospital lien requires the hospital be reimbursed for their expenses from the compensation you are awarded from your car accident settlement, thereby reducing the amount of compensation you are expecting to receive from the auto accident settlement. Even when the hospital bills are rightfully covered by your insurance plan, getting a lien cleared can be a complicated and lengthy process that can delay you receiving your settlement money. Therefore, it’s prudent to address the bills from the get go to avoid any delays in getting your money and to avoid a potentially negative impact on your credit report.

Steps to Take After Receiving a Bill from the Hospital After an Auto Accident

• Your first step is to contact the hospital. Request the hospital send the bill directly to your coverage provider, whether this be Medicaid, Medicare, or a private health insurance provider. Ensure they have your correct insurance information on file. If there is a discrepancy, or they don’t have your coverage information on file at all, provide them your insurance card information.
• If the hospital refuses to send the bills to your health insurance provider, Medicare, or Medicaid, or says they aren’t able to do so, your next step is to contact your health coverage provider directly. Request the proper process to follow for you to send them an itemized copy of the bill so that the health provider can pay it directly. You may need to complete a form and include the original hospital bill to submit to the insurance company. Make copies for your own files. If you already paid the bill in question, request how you can be reimbursed for the charges by your insurance plan.
• Throughout your conversations with the hospital and insurance provider, keep a log including the names of people you spoke with, dates of the conversations, and details of your discussions and any actions expected to be taken. This will allow for easy follow-up if necessary and is also beneficial information to provide your Rhode Island car accident attorney should your unpaid bills not be resolved. Your lawyer can follow-up with correspondence to the hospital and/or insurance companies detailing your attempts to resolve the hospital bills in question. An experienced lawyer has multiple legal avenues to explore to get your medical expenses paid through the proper channels.

Tapalian Law Can Help You

If a hospital lien has been placed on your Rhode Island car accident settlement, it’s important to seek legal help from an experienced Rhode Island car accident lawyer. Attorney David Tapalian has helped clients in this very same situation resolve a hospital lien and have their medical expenses billed through the appropriate means. Don’t let distressing circumstances like this ruin your financial situation, there is help. With over 20 years of personal injury experience, David and his skilled team at Tapalian Law have helped thousands of injured victims seek compensation after being hurt in an auto accident, slip and fall, workplace accident, or other type of injury caused by the fault of another. Call our Providence RI personal injury lawyer at 401-552-5000, for a free consultation for your car accident or other type of injury claim, or contact us online. With offices conveniently located in Providence, Warwick, and Seekonk, MA, we are ready to help you today.