A lot depends on your medical bills. Your doctors, hospitals, therapists, pharmacies, and other health care professionals can’t get paid unless the bills are accurate. Medical bills are a key factor in determining the amount of pain and suffering award. Often insurance adjusters and defense lawyers base their settlement offers on a multiplier of the medical bills. The problem is that many times it is hard to understand what the bill actually means. A lot of what gets written on the bill is for the insurance companies rather than the patient. A good Florida car accident and personal injury lawyer reviews the medical bills for accuracy and completeness.
According to Healthcare in America, many medial bills have some type of error in them. These errors need correction if accident victims are to get what they justly deserve.
What is an explanation of the benefits letter?
Accident victims normally receive two types of documents – a balance due to bill and a formal Explanation of Benefits letter. Normally, the insured will first get the EOB letter. This letter comes from your own insurance company – the one that pays your medical bills until the case is settled or there is a jury verdict. The EOB can come from your primary health insurance carrier, Medicare, or a Florida Med Pay carrier. The EOB document should cover the following:
- What medical services and treatments were provided and when the dates of the services or treatments were
- How much money the physician or health provider charged for the professional service or treatment
- How much money the insurance carrier approved
- Typically, the letter also shows how much is due. This is normally the difference between the amount the health provider charges and the amount the insurance company pays
The EOB letter should clarify that the letter is not a bill.
The bill for services and treatments
This is the document the insurance company sends that shows the submitted bills and how much of the bills were paid. It does direct the accident victim to pay what is due and when the funds are due. The bill isn’t always itemized – doesn’t show specific services or treatments. Normally, the bill shows just a net balance.
Insurance payments are normally based on the insurance codes that were provided when the health provider submitted its bills for services and treatments. The physician is required by federal and state laws to accurately use the right code for the service or treatment. Typically, codes within a general region are the same for each kind of service - such as initial office visit or the cost of an X-Ray. Medicare, Medicaid, or the private insurance carrier normally create the codes. Doctors need to understand which codes apply for the corresponding medical service or treatment. Codes work well because digital entries are easier and faster to process than manual entries.
What can accident victims do if they question the medical bills?
Victims should ask their Florida personal injury lawyer to review the bills for accuracy. The attorney will normally ask the physician or health provider for a copy of the itemized bill that he/she submitted to the insurance carriers or federal payors like Medicare. Patients also have the right to ask for an itemized bill from their insurance carrier
Payment of medical bills
Some medical bills are paid by the accident victim’s own insurance carrier or by an agency like Medicare. Any bills that are due to treatment for accident-related injuries should be part of any demand by the personal injury lawyer. The defendant’s liability insurance carrier should pay any outstanding bills. Also, the liability carrier may need to pay for the medical bills that were paid by the victim’s insurance company or by a relevant agency. Essentially, the liability carrier then reimburses the original payor.
Letters of protection
Often, a victim of a slip and fall, car accident, product defect, or medical malpractice can’t pay all the medical bills. Many times, they don’t have enough insurance or don’t have any insurance. The problem is they still need medical care to get better. Many doctors, psychologists, therapists, and other health professionals understand this problem. They will then normally agree to take a letter of protection. In this letter, the accident victim and the attorney for the accident victim will agree that the health care provider will be paid off the top if there is a settlement or a jury verdict.
Doctors often agree to delay their payment because they know the victim’s lawyer is essentially fighting for them. They also agree because the LOP means they will be paid first before the accident victim is paid.
The medical bills must show each day of service and each treatment. These individual days and services add up to show the victim’s total physical and mental suffering. Numerous trips to see a physical therapist and/or a pain management doctor indicate the accident victim was in severe pain. Insurance companies generally will not offer as much if a patient only sees a doctor or health professional-just a few times.
Lawyers, insurance companies, and even the patients often understand that the amount the physician or medical provider charges is much more than what the insurance provider pays.