Understanding your Medical Bills and your health insurance When you have been in a Palm Beach Car accident

Understanding your MEDICAL BILLS and Negotiating with health insurance carriers.

Something to which an attorney must pay close attention is the West Plam Beach car accident victim / injury client's insurance carrier and their responsibility for paying medical bills. Now most insurance companies have what they call a subrogation clause in their insurance contract with the insured.

What a subrogation clause in most insurance policies will state is that if there is recovery from a third-party for conduct that causes physical injury to the client, then the recovery from that third party shall be used to pay back the insurance company for monies that they had to spend in connection with payment of medical bills that were directly brought about as a result of the injury.

In addition to subrogation clauses within insurance contracts there are state statutes that entitle medical care facilities that cater to the public or are state-owned to recover monies from personal injury car accident settlements that came about as a result of third-party negligence.

There is also the issue of worker's compensation in which an individual is injured in a car accident on the job and is entitled to Worker's Compensation Benefits which are used to compensate the individual for medical bills that are concurrent to the injury. In Florida ,workers compensation carriers that extend funds to provide medical care for the injured party are entitled to a recovery from the eventual proceeds of a personal injury car accident case.

Occasionally, a situation may develop in which your medical care provider refuses to deal with your insurance provider. The injury attorney must quickly and aggressively move to curtail this problem in your favor. The car accident injury lawyer or attorney has to write letters as well as to make phone calls to the billing manager of the medical care provider or the insurance company or to the contact person at the insurance company reminding them that there is a contractual compulsion which requires that the medical insurance provider pay the healthcare provider for injuries sustained in a car accident until such a time as the car accident conflict is resolved and funds are available to subrogate a health insurance provider.

Another dilemma that occasionally develops is one in which the client's medical care provider does not want to deal directly with the health insurance carrier but instead wants to deal with you or your car accident injury attorney. The reason they do this, in many instances, is because they have a contractual agreement with the health insurance provider which limits the number of dollars that they are able to recover for any given procedure. For example, if arthroscopic surgery is sold at a retail rate of $10,000, that particular surgeon, by agreeing to accept clients who are insured from a particular provider, in most cases will necessarily agree to take less than the full retail rate of $10,000. Some of the billing people from certain surgeons may decide to circumvent their contractual agreement, not only with the insurance carrier, but also with the injured party by attempting to acquire retail recovery for the services performed.

In this case, your car accident or automobile injury attorney must contact the medical care provider and remind them that they are under a contractual obligation to tender services at a particular contractually agreed rate with the carrier. And just because there is the potential for personal injury money to be recovered, there is nothing to negate their contractual obligation.

Another issue that must be addressed when dealing with health insurance carriers that are attempting to assert subrogation rights against personal injury coverage, is that it has been the author's experience that in many instances they are willing to negotiate on just how much they can recover. This negotiation is well justified because in many instances the cases will settle and the client does not receive full and fair settlement value for their injuries in a theoretical sense because of complications that arose during the course of litigating the case. Some of these complications may include questions as to liability, questions as to the coverage, and questions as to the comparative negligence. You may have a permanent injury which could surface later on and you may not have been fully compensated for it because of contingency car accident injury attorney's fees. All of these issues must be articulated by the car injury victim lawyer in order to get some back-end recovery for you, the client. You must also remember that in most cases you are only entitled to one bite at the apple. That means that once you settle with the defendant, you cannot go back in a few years and ask for more money.