Help?

[u/kaileypruett]

I was in an accident in January and the bill itself said around $10k, but on my hospital account website it said my portion was around $400, but it was covered by insurance. I thought "my portion" was what insurance didn't cover? Anyways, my insurance came back saying they aren't covering anything because the at fault person's insurance should cover it. The at fault car insurance is settling with the full amount of the bill, but does the revoking of coverage from my health insurance mean I now owe the hospital $10k? Or just my portion, the $400 ish? Thanks in advance, I'm so ready for this to be over.

[u/EmZee2022]

If rhe at fault person's insurance is covering it, it means that their auto insurance is paying the bill.

The most you should owe is the 400. Possibly not even that.

[u/kaileypruett → u/EmZee2022]

Right, they have settled with me for 11k which would cover everything, I was just wondering if my insurance denies coverage, does that deny the whole 10k for the hospital bill or just the 400 it says I owed? Because if they are only revoking the 400 I'm about to come into quite a bit of money, you see? Haha

[u/EmZee2022 → u/kaileypruett]

Ah - yeah, you'll be expected to pay that.

You may be able to make the hospital accept the in-network rate, which may have been less than 10K.

[u/kaileypruett → u/EmZee2022]

That's interesting, thank you!

[u/Cloudy_Automation]

This is more of an auto insurance question than a hospital billing question, but here are a few comments. There are no negotiated rates for automobile accidents. Sometimes your health insurance will pay, and then go through a subrogation process to recover the money from the other party. But it's now likely that your uninsured motorist coverage will cover the bill if the other party was uninsured or underinsured, if your uninsured coverage limits were high enough. Then, your auto insurance will get what they can from the other party's insurance. If the other party had a high enough liability policy, they will cover it, but you may need to sign a release that this is the entire payment, meaning you can't go back and claim pain and suffering damages later. If you aren't willing to sign the release, you need to sue the other driver for both your damages and the hospital repayment.

It may be worthwhile to contact a personal injury attorney for advice, as you may suffer from some delayed injury symptoms caused by the accident.

[u/No-Produce-6720]

If the hospital has already subrogated, you wouldn't owe anything, including the $400.

If their claim has not yet gone through subrogation, it needs to.

This would apply to any medical bills from that day, including physician charges.

[u/kaileypruett → u/No-Produce-6720]

Google explanation makes it seem like that means it should be handed off to the at fault insurance?The at fault insurance is settling with me and saying I need to handle the medical bills myself once they've paid me out. They are covering the full amount of all the bills I really just want to know if my insurance is revoking everything leaving me with a 10k balance, or if they're just revoking the payment for "my part" leaving me with almost 10k payout haha

[u/No-Produce-6720 → u/kaileypruett]

Your health insurance isn't responsible for these bills. Whatever they have paid out will be retracted from the providers it was given to. At that point, the other drivers insurance is responsible for payment, not you. That's what subrogation is.

Have you already settled the claim and received payment?

[u/kaileypruett → u/No-Produce-6720]

Yes I know that is why they rejected them but they already paid out according to my bills so I'm trying to figure out what all I'm about to have to pay. I have not settled the claim and received payment yet which is partially why I'm asking. They are offering enough to cover the full shown medical costs on the bill almost exactly. But when I see a 10k bill showing all my scans, the emergency visit, etc. and it says my insurance covered it all at the bottom, but my online account shows I owed $400 for "my portion" of an emergency visit, I figure my insurance covered all but that $400 portion of my emergency visit, so that is what I should pay. But when I go to that payment in my online account, it says I owe $0 because insurance covered "my portion" too. Why would insurance cover everything else and then "my portion" as well separately like that? Is this just purposeful confusing bs or is there any other reason I wouldn't be expected to pay the full initial bill besides my health insurance?

[u/No-Produce-6720 → u/kaileypruett]

You aren't expected to pay anything, because both you and your health insurance are NOT liable for any portion of this bill. The at fault insurance is. You are not responsible for any part of the claim, because you are not at fault. The way the charge is posted on the hospital's billing system may appear confusing, but bottom line is, the $400 is moot, as you and your coverage are not the billable party.

Unless.

You have settled the claim before all bills were subrogated and included in your settlement. If you settle without all bills being considered, you would then become the responsible party, and your health insurance would likely deny claims because there was at fault coverage. In this scenario, you could find yourself on the hook for the entire charge.

Moral of the story is this. You owe nothing. No copay. No coinsurance. No deductible. Do NOT pay anything, even the $400, and do NOT settle until all charges have been added to your case, because as part of any settlement agreement, you will assume financial liability beyond the date of settlement.

[u/kaileypruett → u/No-Produce-6720]

I understand that part. But they are not directly paying anything at all so I DO have to pay the bills. They are paying me and I have to use that money to pay the bills. I have not paid anything and won't until I have that money. I only had two bills, this hospital one and my ambulance one and the settlement I'm being offered covers the full amount of both. Again, just trying to figure out how that billing works. Sounds like the insurance somehow covered every cent of that visit and it will all be taken back so I'll use the settlement to pay the full 10k.

[u/No-Produce-6720 → u/kaileypruett]

Do you have an attorney? I think at this point you likely need one to handle this for you, because payment should be sent to the hospital directly from at fault. You should not have a hand in that. They would pay your providers directly, and those bills would be subtracted from your final financial settlement. You should not be involved in anything, other than making sure that all of your bills have been included and sent to at fault.

You need someone looking out for your financial interests within the legal system, and if you haven't contacted an attorney, I'd really encourage you to do so.

[u/Environmental-Top-60]

This is a concept known as coordination of benefits.

The at fault insurance company needs to pay first. If there's anything left, then it CAN go to medical with supporting documentation.