Medical Costs: You Have Options

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November 23, 2016

When an accident requires medical treatment, there are two common payment options: (1) Bill your health insurance to pay as you go; or (2) Request that your attorney execute a lien with your providers guaranteeing payment at the time of recovery. Even if you have terrific health insurance, the facts of your case should dictate which option best suits your needs.

 

Health Insurance

 

o Pros

 

The primary benefit of using health insurance is that most of your medical bills are paid regardless of the outcome of your case. If liability is unclear, or if other factors have weakened your claim, this is a tremendous advantage and allows you to pursue your claim with little risk of being financially responsible for the entirety of your  treatment costs.

 

o Cons

 

1.  There is the possibility that your health insurance will not pay all of your doctors’ bills. In this case, some doctors require immediate payment of the remaining balance. If you are unable to pay the balance, these bills can be sent to collections, resulting in attempts to collect the debt and damage to your credit score.

 

2.  You will be required to pay your co-pays throughout your treatment. This can be an overwhelming financial burden. For example, if you attend an average of three physical therapy treatment sessions per week for twelve (12) weeks, paying a co-pay of $30 per visit would result in $1,080.00 in co-pays alone.

 

3.  You are limited to choosing a doctor in the insurer’s preferred network. At times, this can complicate finding a competent doctor in a convenient location.

 

4.  Your medical providers may have what is known as a capitated billing agreement with your health insurer. This means that instead of billing your insurer for your treatment specifically, your doctor is paid a previously negotiated amount by your health insurer.  Because your doctor is paid virtually the same amount regardless of what treatments you receive, this arrangement encourages doctors to recommend inexpensive treatment plans in order to maximize their profits.  Under such circumstances, greed can affect the quality of your care.

 

Liens

 

o Pros

 

1.  Individuals with no health insurance can receive the medical treatment they need without paying anything up front.

 

2.  Many lien providers maintain more detailed, legible records. This is crucial when presenting a claim. If an adjuster has to struggle through scattered hand-written notes, a settlement offer may not reflect essential pain complaints and doctor impressions.

 

3.  In the unlikely event that the case goes to trial, treating physicians may need to testify. Some doctors, especially those who bill health insurance, may be unwilling to cooperate. This can jeopardize the claim at its most important stage.

 

o Cons

 

Your case is collateral for the cost of medical treatment. If you do not recover enough to satisfy your doctors, you become personally responsible for the debt.

 

Which payment option will leave you with the most money in your pocket? As stated above, each payment method has distinct advantages. Consult with an attorney who can evaluate the subtleties of your claim and determine which option is best for you. If you have any questions about this or any other topic, please feel free to contact our office for a free consultation. We will help you find the information you need to make an educated decision that is right for you.

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