Auto Accident Victim's Medical Bills
If you have been injured in a motor vehicle accident in Pennsylvania, you may be entitled to have your medical bills paid regardless of who was at fault in causing the accident. Pennsylvania law requires all motor vehicle insurance policies to contain provisions for payment of medical bills, without regard to fault. Even if you do not have your own policy of auto insurance yourself, you may be entitled to medical coverage: (1) under a policy purchased by someone else who was involved in the accident; (2) under a policy of a relative with whom you reside; or (3) under the assigned claims plan. The amount of coverage for such medical bills depends upon the policy limits of the applicable insurance, but all policies are required to provide for a minimum of $5,000.00 in medical benefits.
If your medical bills are greater than the monetary amount of the medical coverage provided by an auto policy, you may still be able to recover for such bills. In some cases, the medical bills can be paid as a part of damages to which you may be entitled to recover against the person who was at fault in causing the accident. The payment may come either from that party's automobile liability insurance policy or, if your bills exceed the limits of that policy, from the underinsured motorist provisions of your own or somebody else's auto policy. You may also be entitled to payment of these bills through your Blue Cross or similar medical insurance plan, if you have one. If there is no such available coverage, you may be qualified for medical assistance under a state or federal governmental program.
You should be sure to inform you doctor or health care provider that your injuries are motor vehicle-related, so that they will know to bill the proper insurance company. Usually, payment is made without a problem and you may not even be aware who has paid the bill on your behalf or when it was paid. There are no deductibles or co-pays required under an auto policy.
Sometimes, however, an insurance company will refuse to pay a bill, contending that it did not relate to an automobile accident, that the medical services are not necessary or that, for some other reason, you are not covered under their policy for medical benefits. If this happens, you are entitled to know the precise reason that the insurance company has refused payment. You should find out from your doctor the name of the insurance adjuster who has denied coverage, and contact that person for a full explanation of why your bills are not being paid.
Sometimes you will find that payment of medical expenses has been denied simply because the medical care provider has not provided adequate documentation of the medical services rendered. If this is the case, you should arrange for a meeting, or conference call, between the insurance adjuster, you and your medical care provider. Make sure that the insurance adjuster states specifically what further information is necessary from the medical care provider, and make sure the medical care provider understands the requirements and will supply the information requested.
Sometimes the insurance company refuses payment because it contends that either the medical treatment rendered was not reasonably necessary or because the injury for which it was rendered was not caused by the accident in question. In many such cases, you will receive notice that your case has been sent to a peer review organization to determine whether the treatment rendered by your health care provider was reasonable and necessary under the circumstances of your case. A peer review is simply a reconsideration of your case by another doctor for pur-poses of gaining a "second opinion" as to whether the treatment rendered was appropriate.
If the peer review determines that the treatment was not reasonable and necessary, the insurance company does not have to pay the medical bills submitted by your medical care provider. The law also provides that you personally cannot be billed by your medical care provider for those services either. Both you and your medical care provider have the right to request a reconsideration of the peer review report. You also have the right to have the Court make a final determination of your right to have your bills paid as first party benefits.
The rules and regulations pertaining to the payment of medical claims arising out of motor vehicle accidents are complicated and, quite frankly, often confusing. If you have any questions concerning your rights to such payment, consult the attorney of your choice for a thorough review of your options. Your attorney will help you to secure the prompt payment of the maximum amount to which you are entitled under the law. 5/11
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