Legal Resource
Medical Bills After an Accident
Understanding how medical expenses are handled after a personal injury accident and navigating the complex billing process
Disclaimer: This guide provides general information about handling medical bills after Oregon accidents, is not legal advice, and does not create an attorney-client relationship. Consult a licensed Oregon attorney about your specific circumstances before taking action.
How Medical Bills Are Paid After an Accident
After an accident in Oregon, medical bills can be paid through various sources. Understanding this process helps ensure your treatment continues without interruption and protects you from unnecessary financial stress.
The Medical Bill Payment Process
When you receive medical care after an accident, your medical bills may be covered by several different sources, generally in the following order:
- Personal Injury Protection (PIP) Insurance:
In Oregon, your auto insurance includes mandatory PIP coverage of at least $15,000. This coverage applies regardless of who was at fault for the accident and typically pays first. PIP covers reasonable medical expenses, 70% of lost wages (up to limits), and essential services you cannot perform due to your injuries. Benefits apply to expenses incurred within two years of the crash, and insurers may require timely notice and periodic documentation, so report treatment promptly.
- Health Insurance:
Once PIP benefits are exhausted, your health insurance typically covers additional medical treatment, subject to your policy's deductibles, co-pays, and coverage limitations. Your health insurer will likely assert a right to reimbursement from any settlement you receive (known as "subrogation").
- Medicare or Medicaid:
If you have Medicare or Medicaid, these government programs may cover medical expenses after PIP is exhausted. Like private health insurance, they have a right to reimbursement from your settlement.
- Medical Payments Coverage:
Some auto insurance policies include optional Medical Payments coverage, which provides additional coverage for medical expenses beyond PIP limits.
- Settlement or Judgment:
Ultimately, if another party was at fault for your accident, their liability insurance should compensate you for all medical expenses through a settlement or court judgment. However, this typically happens at the end of your case, which could be months or years after the accident.
Medical Provider Billing Practices
Understanding how medical providers bill for services can help you navigate the process more effectively:
- Bills vs. Statements: You may receive both bills (requesting payment) and statements (showing account activity) from providers. Don't assume you need to pay immediately if insurance should cover the treatment.
- Billing Codes: Medical bills use standardized codes to describe services. Review these for accuracy, as coding errors can affect coverage.
- Multiple Bills: For a single emergency room visit, you may receive separate bills from the facility, physicians, radiologists, and labs.
- Balance Billing: Some providers may bill you for the difference between their charges and what insurance paid. Oregon law protects patients from balance billing in certain circumstances.
Understanding Health Insurance Liens and Subrogation
When a health insurer pays for accident-related medical treatment, they typically have a right to be reimbursed from your settlement. This is known as "subrogation" or a "lien" on your settlement.
Types of Medical Liens
- Private Health Insurance Liens: Most health insurance policies include subrogation clauses allowing the insurer to recover payments made for accident-related treatment.
- Medicare/Medicaid Liens: Federal and state laws give these programs strong recovery rights for accident-related medical expenses they cover.
- Hospital Liens: Oregon law allows hospitals to place liens on personal injury settlements for unpaid medical bills.
- Provider Liens: Doctors and other medical providers may also assert liens for unpaid bills.
The Made Whole Doctrine and Lien Reduction
Under Oregon's "made whole" doctrine, an insurer's right to reimbursement may be limited if you haven't been fully compensated for all your damages. Additionally, attorney involvement often results in lien reductions:
- Common Fund Doctrine: When an attorney secures a recovery that benefits both you and the lienholder, the lienholder may need to contribute to the attorney fees by reducing their lien.
- Negotiated Reductions: Experienced personal injury attorneys can often negotiate significant reductions in medical liens, especially when settlement funds are limited.
- Proportionate Reduction: If your case settles for less than full value due to factors like liability issues or policy limits, liens may be reduced proportionately.
What to Do If You Can't Pay Your Medical Bills
If you're facing medical bills you can't pay while waiting for your personal injury case to resolve, consider these options:
Options for Managing Medical Bills
- Treatment on a Lien Basis: Some medical providers will agree to provide treatment without upfront payment if you sign a "letter of protection" guaranteeing payment from your settlement.
- Payment Plans: Many providers will establish reasonable payment plans for patients with accident-related injuries.
- Hospital Financial Assistance: Most hospitals offer financial assistance programs that can reduce or eliminate bills for qualifying patients.
- Medical Bill Advocates: Professional advocates can review bills for errors and negotiate reductions.
- Medical Credit Cards: Some patients use specialized medical credit cards, though these should be approached cautiously due to potential high interest rates.
Working with Medical Providers
Communication is key when dealing with medical providers about billing issues:
- Inform providers about your accident and insurance situation at the time of treatment
- Respond promptly to billing inquiries and keep records of all communications
- Request itemized bills and review them carefully for errors
- Contact the billing department directly if you receive bills that should be covered by insurance
- Be proactive about setting up payment arrangements if necessary
Johnson Law, P.C.'s Approach to Medical Bills
At Johnson Law, we take a comprehensive approach to handling medical bills for our clients:
How We Help With Medical Bills
- Insurance Coordination: We ensure your medical bills are properly submitted to applicable insurance coverages.
- Provider Communication: We communicate with medical providers about your personal injury case, often preventing bills from being sent to collections.
- Lien Tracking: We maintain a comprehensive list of all potential liens and reimbursement claims against your settlement.
- Lien Negotiation: We negotiate with lienholders to reduce their claims against your settlement, maximizing your recovery.
- Provider Networks: We can refer you to quality medical providers who understand the personal injury process and may be willing to treat on a lien basis.
- Final Disbursement: We ensure all legitimate medical liens are resolved from your settlement, protecting you from future collection actions.
Our Fee Promise
Johnson Law, P.C.'s client-first approach to attorney fees provides additional protection regarding medical bills. We charge our attorney fee only after your medical bills have been paid. This ensures that your physical recovery comes first, both medically and financially.
Medical Bill Management
Tips for Managing Medical Bills After an Accident
Follow these guidelines to help ensure your medical bills are properly handled
Keep Detailed Records
Maintain a file with all medical bills, insurance correspondence, and proof of payments. Document when bills were received and when insurance was billed.
Review Bills Carefully
Request itemized bills and check for errors like duplicate charges, incorrect service dates, or services you didn't receive. Billing errors are surprisingly common.
Track Insurance Payments
Review explanation of benefits (EOB) statements from your insurance companies to ensure they're properly covering your treatment according to your policy.
Communicate Proactively
Inform medical providers about your accident case and provide insurance information. Follow up on billing issues promptly rather than ignoring them.
Understand Coverage Order
Know which insurance applies first (typically PIP, then health insurance) and ensure bills are submitted in the correct order to maximize your coverage.
Seek Professional Help
An experienced personal injury attorney can help navigate complex medical billing issues and negotiate with providers and insurance companies on your behalf.
Medical Bill FAQs
Frequently Asked Questions About Medical Bills
Common questions about handling medical expenses after an accident
Should I use health insurance or wait for the settlement to pay medical bills?
Always use available insurance (PIP and health insurance) to pay for medical treatment as you receive it. Waiting for a settlement to pay medical bills can damage your credit, result in collection actions, and potentially limit your access to necessary treatment. When your case settles, your attorney will address reimbursement to insurance companies, often negotiating reductions in these amounts. Using insurance also typically results in lower overall medical costs due to contracted provider rates.
What happens if my PIP coverage runs out before I'm done with treatment?
If your PIP coverage (minimum $15,000 in Oregon) is exhausted before your treatment is complete, your health insurance typically becomes responsible for covering additional treatment, subject to your policy's deductibles and co-pays. If you don't have health insurance, some medical providers will continue treatment on a lien basis, agreeing to wait for payment until your case settles. Your attorney can help coordinate with your medical providers if PIP benefits are exhausted.
Can medical providers bill me directly instead of billing insurance?
Generally, if you provide your insurance information to medical providers, they should bill your insurance rather than billing you directly. In Oregon, medical providers typically must bill PIP insurance for accident-related treatment before seeking payment from patients. If you receive direct bills for services that should be covered by insurance, contact the provider's billing department to ensure they have your insurance information. Your attorney can also assist with resolving improper billing issues.
Will my health insurance company take my entire settlement?
No, your health insurance company cannot take your entire settlement. While they have a right to reimbursement for accident-related treatment they covered, this reimbursement is subject to several limitations. Under Oregon's "made whole" doctrine and the "common fund doctrine," health insurance liens are often reduced to account for attorney fees and to ensure you receive compensation for your injuries. An experienced personal injury attorney can often negotiate significant reductions in health insurance reimbursement claims.
What if I receive bills while my case is still pending?
If you receive medical bills while your case is pending, don't ignore them. First, ensure the provider has billed the appropriate insurance (PIP first, then health insurance). If the bills are for amounts not covered by insurance, contact the provider's billing department to explain that you have a pending personal injury claim. Many providers will place accounts on hold or establish minimal payment plans once they understand your situation. Provide your attorney's contact information to the billing department, as your attorney can often help resolve billing issues and prevent accounts from being sent to collections.
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