by jlazarus » Tue Mar 09, 2010 06:03 pm
My son was in a very serious accident last year - no other vehicle involved (well, he says another car bright lighted him and swerved in his lane and then he swerved to keep from colliding and ended up hitting a concrete culvert on the side of the road).
But I digress..Anyway, his hospital bill was almost 100,000. He had some very serious injuries (cerebral hemorrhage, fractured neck at c3/c4, severe facial and scalp lacerations, broken sternum, etc.). Thank goodness is has not permanent injuries (read: no spinal cord damage) other than some pain and facial scars.
We have health insurance through Blue Cross Blue Shield, but a $5000 deductible. For this reason we also carry Med Pay on our vehicle policies (we have 5 vehicles - $5000 med pay on each).
Once the big hospital billed was filed with our health insurance, we had a balance of $8331.36. We then called State Farm Auto to inquire about filing a claim for the $5000 med pay (to pay the hospital, so that we would only have $3331.36 remaining). At this point, we had met our out of pocket for the year on the Blue Cross Blue Shield, so all the remaining med bills (doctors, scans, etc.) were to be paid at 100%.
State Farm said they would send us an "Authorization for Release of Information" and we should sign that and send it back with any medical bills. While waiting on the "Authorization for Release of Information", I went ahead and faxed them the hospital bill.
**HOWEVER, the "doctors group" (surgeons, radiologists, etc) that saw my son in the hospital somehow found out about our State Farm Policy (I don't know how - I didn't tell them) and they actually sent invoices DIRECTLY to State Farm (circumventing me). State Farm says they received those before they received the hospital bill that I sent them. (which I think is odd, but ok)...And before I even knew what was happening, the doctor's group had completely exhausted our $5000 med pay!! I never saw a penny of it - and, of course, still owe the hospital the full $8331.36. I never even had a chance to sign and return the "Authorization fofr Release of Information" back to State Farm (which I thought was required for them to proceed with the claim but apparently not)...
That doctor's group then ALSO filed with my BCBS policy for some of the same services and was paid AGAIN by BCBS (which, as I stated earlier, was paying out at 100% now since we had exceeded our out of pocket limits for the year). If they had just kept their fingers off my med pay, they would still have received payment from BCBS and I would only owe the hospital $3331.36 instead of over $8331.36.
So here I am, thinking I am well insured, and instead the hospital is of course wanting their $8331. I advised that I couldn't pay that and could they please work with me while I try to get the doctor's group to pay it back and they said no and sent me a summons (less than 180 days after the accident - doesn't this seem a bit aggressive???). I have never been sued, we have great credit, and I am really humiliated by this whole thing!
But I was reading some posts here today and saw where someone suggested that some states have STACKABLE med pays! We live in Mississippi. How can I find this out? If med pays are stackable in my state, couldn't I claim the $8331 on the other med pays on vehicles on our policy? It seems to me that this would solve my situation!!!!! Please advise!! Thanks so much!!
But I digress..Anyway, his hospital bill was almost 100,000. He had some very serious injuries (cerebral hemorrhage, fractured neck at c3/c4, severe facial and scalp lacerations, broken sternum, etc.). Thank goodness is has not permanent injuries (read: no spinal cord damage) other than some pain and facial scars.
We have health insurance through Blue Cross Blue Shield, but a $5000 deductible. For this reason we also carry Med Pay on our vehicle policies (we have 5 vehicles - $5000 med pay on each).
Once the big hospital billed was filed with our health insurance, we had a balance of $8331.36. We then called State Farm Auto to inquire about filing a claim for the $5000 med pay (to pay the hospital, so that we would only have $3331.36 remaining). At this point, we had met our out of pocket for the year on the Blue Cross Blue Shield, so all the remaining med bills (doctors, scans, etc.) were to be paid at 100%.
State Farm said they would send us an "Authorization for Release of Information" and we should sign that and send it back with any medical bills. While waiting on the "Authorization for Release of Information", I went ahead and faxed them the hospital bill.
**HOWEVER, the "doctors group" (surgeons, radiologists, etc) that saw my son in the hospital somehow found out about our State Farm Policy (I don't know how - I didn't tell them) and they actually sent invoices DIRECTLY to State Farm (circumventing me). State Farm says they received those before they received the hospital bill that I sent them. (which I think is odd, but ok)...And before I even knew what was happening, the doctor's group had completely exhausted our $5000 med pay!! I never saw a penny of it - and, of course, still owe the hospital the full $8331.36. I never even had a chance to sign and return the "Authorization fofr Release of Information" back to State Farm (which I thought was required for them to proceed with the claim but apparently not)...
That doctor's group then ALSO filed with my BCBS policy for some of the same services and was paid AGAIN by BCBS (which, as I stated earlier, was paying out at 100% now since we had exceeded our out of pocket limits for the year). If they had just kept their fingers off my med pay, they would still have received payment from BCBS and I would only owe the hospital $3331.36 instead of over $8331.36.
So here I am, thinking I am well insured, and instead the hospital is of course wanting their $8331. I advised that I couldn't pay that and could they please work with me while I try to get the doctor's group to pay it back and they said no and sent me a summons (less than 180 days after the accident - doesn't this seem a bit aggressive???). I have never been sued, we have great credit, and I am really humiliated by this whole thing!
But I was reading some posts here today and saw where someone suggested that some states have STACKABLE med pays! We live in Mississippi. How can I find this out? If med pays are stackable in my state, couldn't I claim the $8331 on the other med pays on vehicles on our policy? It seems to me that this would solve my situation!!!!! Please advise!! Thanks so much!!
Posted: Wed Mar 10, 2010 01:43 am Post Subject:
But I was reading some posts here today and saw where someone suggested that some states have STACKABLE med pays!
I personally have never worked a stackable medpay state...I found a MS case that a won for stacking medpay due to ambiguity in the contract ("other insurance") however, it was overturned..CONCLUSION
But I would ask...because these things change, and I could've missed a more recent case...also look in your policy under the 'med pay' coverage..it should address this, may come right out and say 'no stacking'.¶15. The trial court erred when it found ambiguity in the policies and allowed stacking of the medical
payment benefits. We therefore reverse the trial court's grant of summary judgment in favor of Britt, and we
render judgment here denying Britt's summary judgment motion, granting summary judgment for Farm
Bureau, and finally dismissing Britt's complaint and this civil action with prejudice.
¶16. REVERSED AND RENDERED.
Your son's story about what happened, 'could' bring in another coverage..
(well, he says another car bright lighted him and swerved in his lane and then he swerved to keep from colliding and ended up hitting a concrete culvert on the side of the road).
Many states, (including yours) allow stacking of UM coverage.
..(9) According to the Mississippi Department of Insurance, stacking is allowed based on Allstate Insurance Co. vs. Randall 753 F.2d 441 (5th Cir. 1985).
Did State Farm take a statement from your boy re: the facts of loss?? In that inital statement did he tell them about this other vehicle? In many states, this accident, may qualify for UM coverage (phantom vehicle).It doesn't look like MS requires UM coverage (only bi and pd)...but they don't require MP either and you have it, so you may have UM as well.. You need to determine first, if you have UM, (it will be split limits just like your BI coverage ie 25/50)...Now before you get too excited...I couldn't find the case law on MS re: phantom vehicles...some states require physical contact with the phantom, some do not..so it may not apply, but most certainly worth looking into....do let us know...
Also re: the prior medpay payment to the provider...Did you ask them 'what' authorization they had to pay this?
Posted: Thu Mar 11, 2010 02:10 pm Post Subject:
Thanks for the answer. We have a pretty complicated case!
To answer your questions:
1) - I did call my insurance company Tuesday and asked directly about UM and Med Pay. I have UM - in fact, I think I am probably OVER insured (we have 100,000/300,000 UM - stackable - on all 5 of our cars - mine, my husband's and all three of our kids' cars). I am paying for each of these so I'm thinking, since that is stackable here, I should reduce those amounts perhaps down to 50,000/100,000.
2) However, my agent said "she did not believe my med pays were stackable" - whatever that means :) Basically she said no, but she wasn't totally convincing!
3) I did ask State Farm what authorization they had to pay my med pay to the doctor's group and the adjuster said she just "pays the first invoices she receives"...
4) There were two other people in the vehicle with my son when he had an accident. All three are on record as saying that the other car swerved in their lane. Not only that, but we went out to the scene the next day and saw - on the OTHER side of the road (where the other car was, opposite from where my son went off the road) a dead cat! My guess is that the other car swerved to keep from hitting the cat (but failed to keep from hitting the cat). Sadly though, Mississippi appears, from google case searches I did, to be a "physical contact" state.
On another note, something I did not mention in my original post - we were in court yesterday concerning the $8331 owed to the hospital. The hospital filed suit for that money a few months after the accident. We hired a lawyer who then named the Doctor's Group as a third party defendant since they 'took' my medpay (and billed BCBS) which I had contended all along should have gone to the hospital. If I had been able to offer the hospital the $5000 up front, we most likely would have been able to negotiate the remaining $3331 with them...but since the doctor's group took that money, I had absolutely nothing to leverage with....
So yesterday was the trial and the judge found in OUR FAVOR and said the doctor's group had to pay that $5000 back!!! I was SOOO excited!! Of course, they will probably appeal it and we'll fight another day, but I am feeling so empowered right now!!
Thing is...the lawyer for the doctor's group kept saying that - by law - they (doctor's group) HAVE to exhaust MY med pay before they could bill the health insurance. Which makes no sense because obviously the hospital didn't do that and the judge told that lawyer that she was misinterpreting the statute she was citing to defend this practice.
My point was (and the judge agreed) that I purchased MedPay as a separate and additional premium to my regular Auto Insurance (Liability, Uninsured and Collision). I purchased it to protect me from financial burdens in case of an accident. I have a $5000 deductible on my health insurance and this $5000 Med Pay was purchased specifically to help me offset my deductible if needed. It is a contract entered into by me and State Farm to benefit me - not a third party.
The doctor's group specifically went after the Med Pay first because they have no discount contracts with State Farm (unlike BCBS, with whom they do have discount contracts). The doctor's group, had they billed BCBS first, would (and was eventually anyway) paid at 100% of their "discounted rate". They saw my MedPay as a loophole to circumvent this and get "more money" than if they had billed BCBS only. They basically exploited my policy to benefit them. The judge said that I should NOT be harmed by my own policy benefits.
Posted: Thu Mar 11, 2010 10:32 pm Post Subject:
I am paying for each of these so I'm thinking, since that is stackable here, I should reduce those amounts perhaps down to 50,000/100,000.
I would but check the premium difference first..if it doesn't amount to much, I'd leave it..The doctor's group specifically went after the Med Pay first because they have no discount contracts with State Farm (unlike BCBS, with whom they do have discount contracts). The doctor's group, had they billed BCBS first, would (and was eventually anyway) paid at 100% of their "discounted rate". They saw my MedPay as a loophole to circumvent this and get "more money" than if they had billed BCBS only. They basically exploited my policy to benefit them. The judge said that I should NOT be harmed by my own policy benefits.
That's EXACTLY what they did..we've had another thread or two where a PT outfit did something similar, to another doctor for pete's sake!!! and he was ticked...he finally got his money back as well...I'm happy for you, and hope the attorney didn't cost too much..did you mention the UM possibility to this atty?Add your comment