IF I AM INJURED IN AN AUTO ACCIDENT, WHO PAYS MY MEDICAL BILLS? (AUTO INS. vs. HEALTH INS.)

This question can be very complicated. However, the simple answer is every person is entitled to have all medical bills paid for all reasonably necessary medical treatment arising out of injuries sustained in the auto accident. (exceptions are rare) Determining which company should pay first is not always an easy analysis. It involves a detailed information intake. Most auto insurance policies have coordinated medical plans. Simply put, this means your private health insurance plan pays first according to its rules. This company is most likely primary for the payment of your medical bills. Whatever is left is then paid by the auto insurance company.

If you are a named insured on either your private health or auto plan or you elected the coverage plans for either of your health or auto plans, you will have to follow your private health plan’s rules before the auto insurance company is responsible for paying your medical bills. If you have an HMO, it is important to stay within your network and get the necessary referrals to be eligible. There are some rare exceptions. If you have questions about this please call our office before handling these issues on your own.

If your private health insurance is Medicare/Medicaid, neither is primary and entitled to reimbursement for any conditional payments made pertaining to your auto accident related treatment. If your health insurance plan is a qualified ERISA plan, then it might also be entitled to reimbursement. If you have no health insurance, you are not barred from having the auto insurance pay for your medical bills. If you thought you had coordinated coverage with your private health insurance plan, but later find out you have uncoordinated coverage with your health plan, this fact alone will not bar you from first submitting medical bills for payment to your auto insurance for payment.

Even if you have no auto insurance or private health insurance, you will likely still be entitled to Michigan no-fault benefits in order to submit a claim to get your medical bills paid. The exceptions to this rule are extremely rare.

You only have one year to get any outstanding medical bill paid by an auto insurance company, so if you have questions about which insurance should be paying, which insurance company is primary or having trouble getting an auto insurance company to pay your no-fault benefits for any reason, please contact our office immediately. We specialize in the payment of no-fault benefits. -Suzanne M. Kalka

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