It is important for you to know that there is a war for your medical payments (medpay) insurance – or, if you live in Kentucky, your PIP coverage.
Before they treat you, medical providers – especially chiropractors – will want you to sign a paper assigning your right to receive the PIP or medpay money directly to them. DO NOT DO THIS UNLESS YOU NEED THE TREATMENT ON AN EMERGENCY BASIS.
Here is why.
Medical Payments coverage pays up to a particular limit – often $5,000.00, if you have the coverage – for medical or chiropractic bills you sustain because of an accident. PIP (which is required by the state, in Kentucky) works the same way for up to $10,000.00 in medical bills (The $10,000.00 of PIP coverage can also be applied to lost wages).
Also with PIP, and usually with Medpay, you have the option of requesting that the payments be made directly to you (or to your attorney to be held in trust). At the end of the case, you will still have to make sure that the doctor is paid and the insurance company is paid back, but you might be able to save yourself some pain – and avoid some annoying mail and phone calls – in the meantime.
Some providers – particularly chiropractors, but also hospitals – want you to turn your bills in to the medpay, or PIP, with instructions to pay the hospital or chiropractor directly.
Why? Because the medpay or PIP usually will pay the chiropractor or hospital dollar for dollar. They know that if you have regular healthcare insurance with your employer, such as Anthem or United Healthcare, that insurance will pay them as little as $.30 on the dollar.
Most employers’ health insurance policies won’t pay chiropractors at all. Which means the chiropractor has to wait until the case is settled before they get anything, and then they know your lawyer will probably negotiate a discount on their bill.
Either way, you have to pay back the insurance company – whether it’s Medpay or Employer healthcare coverage – dollar for dollar when you settle the case.
So what should you do? There’s no rule that fits all situations, but here is how I look at it.
1) If you have employment healthcare insurance – like Anthem, United Healthcare, or Humana – I think you are better off submitting your bills directly to that insurance company. The employment healthcare insurance will pay off the doctor or hospital directly at a substantial discount. Which means you have to pay back less at the end of the case than if you have medpay or PIP pay the doctor directly, which will be at the full bill.
2) Another advantage of submitting your bills to the employment healthcare insurance is that you can still use the medpay for some other good purpose. One is paying the doctor or chiropractor whatever is owed on your deductible or copay. Another is using the PIP or medpay money in place of a “lawsuit loan”. Lawsuit loans have ridiculous rates of interest, and you have to pay them back dollar for dollar when the case settles.
3) Another option – particularly if you have no employment healthcare insurance – is not to pay any chiropractic or medical bills at all until the end of the lawsuit. I find it’s easier to negotiate discounts on the medical and chiropractic bills at the end of the lawsuit, because the doctor, chiropractor or hospital knows that this may be his last chance to get the money due him all at once.
4) A last option is to direct payment of your PIP or medpay benefits to your lawyer, and have him hold them in his trust account for you until the end of the case. The advantage of this is that the lawyer can negotiate discounts on both the amount that is paid your doctors, and on the amount that you repay the medpay or PIP insurer out of the settlement.
5)There are good reasons to use Medpay and PIP. If you qualify for PIP, you cannot submit medical bills as part of your personal injury claim in a Kentucky lawsuit to the extent you did not use up your PIP. And if your case is going to the jury, they will learn the total amount that your insurance paid to your doctor. $5,000 in bills looks better when the insurance pays all of it, as opposed to when the insurance pays $1500.00 of it and the rest is written off.
I’d love to talk with you about this. Other lawyers refer their clients to me. And if you decide you‘d rather hire someone else, that’s OK. My phone is 513-621-4775.
Because all situations are different, and because there may be other facts pertaining to your case that I don’t know about, you should not rely on this answer for legal advice. I am not your attorney, and no lawyer client relationship has been formed. All discussions are limited to Ohio law unless otherwise indicated. And past performance cannot be used to predict future results.