Car accidents are commonly affiliated with their fair share of injuries. Therefore, understanding how your health insurance works, what it covers, and how to optimize its benefits can help relieve the stress from accident-related medical costs. With the help of an experienced legal team, you can navigate this confusing terrain and recover from your injuries comfortably.
Understanding Health Insurance Coverage
Health insurance protects you from the overwhelming costs of medical treatment, especially after an accident. However, the specifics of what is covered vary depending on your health insurance plan.
Types of Health Insurance Plans
A diverse range of health insurance plans exists, each with unique characteristics regarding coverage and costs [1]. Considering these plan types might help you make better healthcare decisions. Below are a few common forms of health insurance plans:
1. Health Maintenance Organization (HMO):
HMOs operate on a network-based system, meaning you must choose a primary care physician within their network. Referrals for specialists typically come from your primary care physician. HMOs often have lower premiums but may have stricter rules about out-of-network care.
2. Preferred Provider Organization (PPO):
PPOs provide more flexibility than HMOs. You can visit any physician within the plan’s network without a referral. PPOs also allow for out-of-network care, although it usually comes with higher out-of-pocket costs.
3. Exclusive Provider Organization (EPO):
EPOs, similar to HMOs, require you to stay within their network for coverage. However, unlike HMOs, referrals from a primary care physician are not mandatory for specialist visits.
4. Point of Service (POS):
POS plans blend features of both HMOs and PPOs. Like HMOs, you’ll have a primary care physician and need specialist referrals. However, PPOs allow for out-of-network care at a higher cost.
5. High Deductible Health Plan (HDHP):
HDHPs have lower premiums but higher deductibles, meaning you pay more before your insurance covers costs.
Factors Affecting Insurance Coverage
These factors determine the amount of your coverage and the portion of your medical expenses your insurance will cover.
Medical Payments Coverage
Your auto insurance policy might have medical payments coverage or “MedPay.” This coverage helps pay medical bills from a car accident, regardless of who was at fault. Under §10-4-635(2)(b), C.R.S., Medpay will cover medical treatment up to the amount covered under your auto policy following the incident. Unlike health insurance, MedPay is not entitled to seek reimbursement for the amounts it covers. As such, one should consider increasing the amount available under their auto policy, as Medpay is often the first line of defense against excessive medical debt. Talking with your insurance agent can clarify your specific policy and coverage.
Primary vs. Secondary Coverage
Understanding the interplay between auto and health insurance is critical when receiving medical care following a motor vehicle collision. Indeed, where the fault is apparent, the at-fault party’s auto insurance may be obligated to cover the costs of your collision-related medical expenses. However, under state and federal laws, your health insurance may still cover the costs of your treatment, understanding that out of any settlement, your health insurance is entitled to seek the amounts paid. For a detailed look into this concept, see _____.
We strongly encourage our clients to have their medical expenses processed through their health insurance rather than sent over to the at-fault party’s insurance. Doing so ensures:
- Your medical providers are timely paid for the services performed, which avoids any risk of the medical expenses going unpaid and being turned over to collections;
- Protects our client’s sensitive medical records from being disclosed to an unknown and adverse party;
- Allows you, as the injured party, to maintain complete control over the outcome of your claim.
If one elects instead to submit their medical bills to the at-fault party’s auto insurance for payment, they risk jeopardizing the actual value of their claim. At Killian Davis, we pride ourselves on obtaining the best possible outcome for our clients. If you or a loved one have been injured due to no fault of your own, call us at 970-241-0707. We will help get you what you deserve.
Coordination of Benefits
When multiple insurance policies are involved, coordination of benefits plays a crucial role. This process ensures you are only reimbursed once for the same medical expenses. For instance, if your health and auto insurance are active, they will coordinate to determine their responsibilities in your case. As mentioned, one policy is the designated primary coverage, which pays first. The secondary coverage then kicks in to cover any remaining eligible expenses.
Understanding the coordination of benefits helps you navigate your claims more efficiently. It guarantees that your medical expenses are covered appropriately without delays or complications. Knowing how your insurance policies interact, you can better manage your coverage and avoid potential issues with overlapping benefits.
Exclusions and Limitations
You should also understand the exclusions and limitations of your insurance policies after a car accident. Both auto and health insurance policies come with specific situations or types of medical expenses they may not cover. For example, pre-existing conditions might be excluded from coverage, leaving you responsible for those costs.
Experimental treatments often fall under limited coverage, meaning your insurance may only partially pay for these procedures. Knowing these exclusions and limitations helps you manage your expectations and avoid surprises when filing claims. It’s essential to read your policy documents thoroughly to identify any potential gaps in coverage.
Maximizing Insurance Coverage After an Accident
Even with the complexities of health insurance and car accidents, you can take steps to receive the maximum coverage available. Understanding your coverage policies and treatment options and effectively managing your claims are crucial to navigating this process successfully.
Network Providers and Treatment Options
Choosing where you receive medical treatment after an accident can significantly impact your insurance coverage. Whenever possible, opt for healthcare providers within your health insurance network. In-network providers have pre-negotiated prices with your insurance company, which can considerably minimize out-of-pocket payments. Your careful selection of providers helps you maximize your coverage benefits and minimize personal costs.
Reimbursement and Claims Process
Navigating the reimbursement and claims process for accident and medical insurance can be complex. It is essential to keep detailed records of all accident-related expenses. These expenses include medical bills, prescription receipts, and documentation of lost wages. These records serve as evidence for your claims and support your pursuit of reimbursement.
Start by filing a claim with your auto insurance, especially if you have “MedPay.” You will also need to file a claim with your health insurance company, providing them with details of the accident and any bills you have incurred. Your insurance providers can guide you through the specific procedures and necessary documentation to get compensation.
References
[1] https://www.healthcare.gov/choose-a-plan/plan-types/