by Guest » Sun Oct 23, 2011 04:49 pm
I was rear ended by an uninsured motorist a little over a month ago. I know that my insurance company will try to collect money from him for the car repair, my deductible and my medical bills. Does that process start right away, since the car repair has already been paid for? Does subrogation of medical bills have to wait until treatment is completely finished? My claims agent told me that as long as the at fault driver makes regular payments to them, even small payments, they won't report him for driving uninsured. So he really has no incentive to make more than small regular payments, or at least that is how it seems to me. My insurance hasn't given me any info on this part of the claim. Will they let me know the status of subrogation, or will I only find out anything if they send me a reimbursement for my deductible?
Also, I have $1000 in Medpay. I've been submitting my medical bills and receipts for my copays for doctor visits and physical therapy for the past four weeks, but haven't gotten any of the Medpay yet. Do they wait until I am owed the full $1000 before they reimburse anything, or how soon should I start getting reimbursed?
Thanks for the help.
Also, I have $1000 in Medpay. I've been submitting my medical bills and receipts for my copays for doctor visits and physical therapy for the past four weeks, but haven't gotten any of the Medpay yet. Do they wait until I am owed the full $1000 before they reimburse anything, or how soon should I start getting reimbursed?
Thanks for the help.
Posted: Sun Oct 23, 2011 05:35 pm Post Subject:
Does that process start right away, since the car repair has already been paid for?
It usually won't start until the entire claim is paid. If your carrier us paying for your injury under UMBI then they usually won't pursue the other party until that portion of the claim is settled.So he really has no incentive to make more than small regular payments, or at least that is how it seems to me.
Well, probably. Some states require the insurance company to make the insured whole before they can take dollar one for themselves. That is, some states require the insurance company to pay back their insured before they keep any money for themselves. As your carrier if this is correct for your state. If they "can't" tell you, speak to a supervisor. I'm not a subrogation person but I've needed to collect debts from people who were not insured. I set them up on payment plans. They sign a document agreeing to make those monthly payments. I always told them that they want to pick an amount they can pay but they don't want to pay for the rest of their lives. I'm sure a person with more experience than I would work to make that monthly payment as high as possible. But look at the flip side... if after a few months they have trouble with that payment than they might stop paying all together. That is worse than making small payments.If the person did not have insurance then he/she should have been cited for this. He/She will then be "punished" for that by the state, not the insurance company.
I've been submitting my medical bills and receipts for my copays for doctor visits and physical therapy for the past four weeks, but haven't gotten any of the Medpay yet.
Call your carrier/adjuster and ask about this. They should be paying under MP as the bills come in. But they have 30 days to pay them.Posted: Sun Oct 23, 2011 05:46 pm Post Subject:
Thank you. I will call my medical claims adjuster tomorrow and ask about the Medpay. The at fault driver had just switched insurance companies, he thought he was insured and presented the officer and me with a policy number, agent name and phone number, so he wasn't cited for no insurance. It wasn't until about two weeks after the accident that his new insurance company determined that the new policy wasn't effective on the date of accident. Maybe that is why the adjuster said if he kept up his payments "they" wouldn't contact the State about his lack of insurance, I don't know.
Another Medpay question: I want reimbursed for my copays, as the four weekly physical therapy visits are adding up quickly. But is Medpay counting just the copayments towards the $1000, or are they counting the full medical bill amount? If that is how they are doing it then I've already surpassed the $1000 coverage and won't get my copays reimbursed? I don't think it should be done that way since UMBI should be handling the actual bills from providers, but again no one has clarified for me. Thanks again for any help.
Posted: Tue Oct 25, 2011 04:48 am Post Subject:
You should be covered for everything by the insurance. Since the at fault driver's insurance is not active, let your insurance handle it. Ask your adjuster or an insurance claims person to clarify your doubts, because it really depends what all your particular insurer is going to reimburse.
Posted: Tue Oct 25, 2011 08:27 pm Post Subject:
If this is state mandated Med Pay then your Med Pay under your auto policy should be addressing your entire medical bills up to the limit. But you mention a co-pay. Is this from your health carrier? You should have needed to indicate if this was from an auto accident and if you did, your health carrier probably should not have paid until your auto carrier Med Pay was exhausted. But it's also possible that your state may allow both carriers to pay. It's technical and confusing. If a bill is submitted to your auto carrier and is not paid, then most likely they will pay it under Med Pay (and are require to pay it). Yes, this will leave you to keep paying the co-pay amounts.
Eventually your UMBI coverage should include your out of pocket expenses in your settlement but this won't happen until you are done treating.
If you want, you can report to your state that this person had no insurance at the time of the loss. Some states will suspend the person's drivers license until they can show that they have paid for the loss (payment to your carrier for their UMBI amount). After all, even though you will be paif your loss because you were smart and protected yourself with UM, your carrier will still be seeking to be paid back from the at fault party.
Posted: Wed Oct 26, 2011 12:51 am Post Subject:
I was told by one of my claims handlers to have my doctors bill health insurance like they normally do, which is why I'm paying copays. A different handler said to have doctors bill the auto insurance, but that was after I'd already started treatment, so I didn't have the doctors change how they're billing. They know it is for a car accident though.
I can't get a straight answer or explanation from my insurance, which is frustrating. I misunderstood the initial explanation I was given, she told me they'd reimburse me for my ER copay, and I thought that meant all copays would be reimbursed up to my Medpay limit, and the rest will be reimbursed when I'm done with treatment and ready to settle. Now it sounds like the $1000 in Medpay will pay all medical bills up to the $1000, which means I'll be lucky to get reimbursed even one copay. I don't know how people afford this, I assumed that since I'm insured and have the UM coverage, I wouldn't be out a lot of money, but that isn't how it is. I don't know why I was told to have my doctors bill health insurance, I don't know if that is wrong or making a bigger mess of things, and none of the claims handlers I've talked to will tell me anything.
I guess once it becomes a UM claim it has to be adversarial maybe, because it sure doesn't seem like they're working FOR me.
Thanks for the replies, I've gotten more help here than from my own insurance!
Posted: Thu Oct 27, 2011 01:59 am Post Subject:
Do you have UMBI coverage in addition to Med Pay? Also, what state are we discussing here? In some states Med Pay reimbursements are not subject to subrogation, in other states they are secondary to personal health insurance.
UMBI should provide a higher amount of coverage, but would be subrogatable to the health insurance company since your injuries are the result of a third party claim..
Posted: Thu Oct 27, 2011 04:09 pm Post Subject:
This is Oklahoma. I do have UMBI coverage, and I was told by the Medpay adjuster that once the $1000 in Medpay is used up, all bills will go to the UMBI adjuster but nothing will be done with them until I'm finished with treatment.
Since I have both the Medpay and UMBI, how should my doctors be handling their billing? I guess I don't understand how the medpay works, because I thought it was to reimburse my out of pocket medical expenses, but so far it hasn't done that. Does the Medpay just mean that I won't have to pay back (out of a settlement) that $1000 in medical bills, but I will have to pay my health insurance for everything they pay?
I have tried to read the medpay adjuster every day this week, and they won't even let me leave a voicemail. If my health insurance pays my medical bills, then Medpay is just going to reimburse my health insurance, is that right?
I really, really appreciate the help, this is so frustrating.
Posted: Thu Oct 27, 2011 06:08 pm Post Subject:
MP in OK pays for necessary and reasonable medical expenses. This is any form of a medical expense that is submitted. Bill, co-pay, what ever. Should be paid baseds on when they were submitted. After the MP is gone everything should be considered under UM. Id have health ins pay and submit your co-pays under MP. But if someone sends med bills to your auto carrier, they would need to be paid under MP. When settling under UM, get the settlement amount (negotiate) then go to your health carrier and work out a reduced payment to them (before you accept the UM offer).
Posted: Thu Oct 27, 2011 08:17 pm Post Subject:
Thank you. Since health insurance is paying my medical bills, I don't understand why my auto insurance/Medpay adjuster is requesting medical bills from my doctor. She knows health insurance is being billed for it first, so what if she pays the same bill that my health insurance already paid or is in the process of paying? I wanted the Medpay to cover my copays, but all she will say is "we pay from the actual bill, not your receipt", which I understand but I don't want her to double pay the doctor!
I can't get through to her by phone to discuss this, so I don't know what to do except wait.
Posted: Fri Oct 28, 2011 04:00 am Post Subject:
I don't understand why my auto insurance/Medpay adjuster is requesting medical bills from my doctor.
Sometimes attorneys don't understand this either, and their clients end up with next to nothing as a result.
Essentially, your health insurance should NOT be paying for any of your auto collision injuries and related expenses. Your health insurance is intended to pay only "first party" claims -- injuries you cause to yourself. Although it will, your health insurance has no responsibility for covering "third party" damages -- your injuries caused by someone else (or at work, which would be the responsibility of Workers' Compensation insurance). In your case, with your third party being uninsured, your health insurance will cover your losses, all the while keeping track of what it's costing them, down to the penny.
If you were to hire an attorney to pursue your claim against the at-fault party and managed to recover anything, your attorney takes his 30%-40% off the top, and before you get to put anything in your own pocket, your health insurance company will step up and demand to be reimbursed for 100% of its capital outlay on your behalf.
Shocked, you cry foul! "I'm being ripped off by my health insurance company! I paid my premiums, now they want my money, too?" And the answer is, YES, they are entitled to recover under the SUBROGATION paragraph in your contract, that addresses exactly this sort of situation.
Fortunately, you have MedPay and UMBI in your auto insurance. I don't know for sure if MedPay is subject to subrogation in Oklahoma or not (tcope might know). But UMBI most definitely is. Your auto insurance company needs copies of the health insurance-covered expenses so it knows how much of your coverage is being chipped away with each appointment, treatment, or other service.
When your treatments are complete, your auto insurance company will write a single check to your health insurance company for 100% of its subrogation demand (or whatever you can prenegotiate with them to a reduced amount) -- up to 100% of your UMBI limit.
And, again, if you were to go after the at fault party for your damages, your auto insurance company would be standing in line with its subrogation claim, too.
As far as your auto MedPay "paying from the bill" and not your "receipt", that may be an indication that MedPay is subrogatable in Oklahoma, in which case, the health insurance company needs to be reimbursed first, which will probably leave none of your copays covered by MedPay, but covered under UMBI instead, which is fine.
Your situation is a bit complex, but not unusual, and the only one who's ripping anyone off is the irresponsible idiot who caused the collision and had no insurance as required by law. People like that cause all the rest of us to pay inflated insurance premiums for the coverages we do have.
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