You are in an accident and suffer serious injury. You are taken to a hospital and admitted for several days of medical care. You have paid high premiums over the years for health insurance, and the hospital accepts your health insurance plan. So the bill is covered by your health insurance company, right?
The unfortunate answer is, “not necessarily.” Some hospitals are choosing not to submit your bills to your health insurance company for payment if they think they can get more out of you. You see, when your health insurance company pays the hospital, it pays at a discounted price that was negotiated between the hospital and the insurer. On a $30,000 hospital bill, for example, the hospital may have agreed to accept, say $8,000 from Blue Cross/Blue Shield. But, from you the hospital wants the entire $30,000.
This pernicious practice happens most often when your injuries were caused by the fault of another—like when a drunk driver blows a red light and crashes into you. The hospital sees that you might have a pretty viable claim against the responsible driver and his insurance company, so the hospital rejects your health insurance, with its discounted reimbursements, and comes after your anticipated settlement with the drunk driver to recover its full charges.
So, what is the problem? If you are recovering the bill from the drunk driver, why shouldn't the hospital be able to collect its full bill out of your settlement?
Consider if the drunk driver has only $25,000 in liability insurance. That is all the money you are ever likely to see from him. Now, the hospital wants $30,000 out of the settlement to pay the bill that it had agreed with your health insurance company would be paid at a discounted rate. The hospital takes the entire $25,000 toward its bill, leaving you with another $5,000 to pay. There is nothing left to reimburse you for your lost income or to compensate you for a lifetime of disability inflicted on you by the drunk driver. This, after you had already paid thousands of dollars over the years in premiums for the health insurance the hospital now refuses to accept because they can get more from you.
If you find yourself in this situation, your next call should be to an attorney with experience handling injury claims. That attorney will know how to deal with all of the complicated insurance issues that arise when you are injured by the fault of another. We work on these kinds of cases every day. If we can be of assistance to you, just give us a call.
For an interesting article on this terrible injustice some hospitals are engaging in, go to http://www.kansascity.com/2013/08/03/4387796/area-hospitals-are-being-sued.html and read a good article by Kansas City Star reporter Steve Everly. We'd like to know what you think about this.