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Why should I use my own health insurance if I’m in a car accident that isn’t my fault?

A question that I am commonly asked by my clients is: Why should I use my own health insurance if I’m in a car accident that isn’t my fault?! Shouldn’t the defendant have to pay for that?!

The short answer is…. yes, the defendant should have to pay for the cost of your medical treatment but it’s a little bit more complicated then that.

If you have health insurance, through an employer plan, Medicaid, Medicare or a private plan that you enrolled in, you already know that it reduces the amount of out of pocket cost to you for medical treatment. What you may not realize is that health insurance coverage has two big benefits: (1) your plan is going to pay for some of the cost of your treatment and, (2) your health insurance company has entered into an agreement with health care providers to pay an “adjusted” rate for treatment. If you don’t have health insurance (or don’t use your health insurance when you are treated by a medical provider), you will be responsible for the FULL cost of your treatment.

Real World Examples

After your car accident, you go to the emergency room for treatment. You have leg pain so the ER doctor orders an x-ray of your leg. The full cost of that x-ray is $800.00.  If you have health insurance, your insurance company may have contracted with the hospital to pay an “adjusted” rate of $400.00 for that x-ray. Let’s say you have an insurance deductible of $50.00 that you are responsible for. Your health insurance company will pay $350.00 and the balance left for you will be $50.00. At the end of your personal injury case, when you agree to a settlement or you are awarded a judgment in court, you will only have to pay $50.00 out of your pocket to the hospital for the cost of the x-ray.

Consider the same scenario above but with no health insurance involved. You will be responsible for the $800.00 cost of the x-ray and when you settle or receive a judgment; you will have to pay that full $800.00 (out of the money that should go to you!) to the hospital.

Having health insurance is a wonderful benefit and using your health insurance helps you to walk away with more of your settlement money at the end of your case. The defendant will have to reimburse you for the cost of your treatment. When we tell you to make sure and use your health insurance, we just want to make sure that you get to keep your money!

The Pendleton Law Team Is Here For You 804-250-5050