Strange insurance claim question for Questionland Seattle

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Strange insurance claim question

So, I had a car accident last February. Other person's fault, insurance agreed to pay. I had some injuries, went to physical therapy and massage, got better, closed the claim, and the insurance company paid my medical bills directly. In August. Last month, one of the providers started sending me VERY large bills, saying she didn't get paid enough from the insurance, and it's my responsibility to pay her this extra amount. I've been in contact with the insurance company, and saying they'll look into it, but haven't been able to give me a definite answer about who's going to pay this. Am I screwed? Am I going to have to pay this ridiculously huge bill? Do I need a lawyer? If this lady fucked up her paperwork so bad the insurance wouldn't reimburse, does that mean I have to pay? Help! The bill is huge!

B asked in Insurance about 1 year ago | Report

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That sounds kind of screwy to me. Medical insurance companies pay a "negotiated" amount for any procedure, which can be jaw-droppingly low if the insurance company is especially nefarious (my old insurance regularly paid out a few cents for lab tests). Do auto insurance companies pay the same rates? Or do they pay the amount in toto?

I'd be very curious to find out if the insurance company paid the prevailing negotiated amount for your medical bills, and this provider is now trying to scam you for the rest. I've heard of large medical institutions who try to scam the elderly and otherwise naive people by billing them for whatever Medicare/insurance didn't pay, which is outright illegal. My knee jerk reaction is to take the side of anyone/anything against any insurance company, but I'd still ask some questions about this.

keshmeshi answered in Insurance about 1 year ago | Report

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If you have PIP coverage on your vehicle, you can turn over all of your medical bills related to this accident to them. PIP is "personal injury protection" and it's meant to pay any accident-related medical costs, even when you're at fault. Usually your PIP coverage will be limited to $10K or $20K, but it doesn't sound like you had much treatment here, so you're likely within that limit.

The advantage of sending bills directly to your insurer to deal with is that your insurance company owes you a duty of good faith & fair dealing, where the other driver's insurer does not. That means they have to be on your side, and if they don't treat you appropriately, you can sue them! So, check with your insurance company to see if you have PIP coverage.

So, as for talking to a lawyer, it would be a good idea to do so before you settle your claim with the at-fault driver. Besides your medical bills, you're also entitled to be reimbursed for other costs, like your mileage for traveling to and from doctor's appointments. And an attorney can help to negotiate a better settlement for pain and suffering - to compensate you for all of the time you've spent at the doctor and activities you haven't been able to do because of your injuries. Also, an attorney can help deal with this billing issue.

Luckier answered in Insurance about 1 year ago | Report

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That sucks. When you go to any doctor, you generally need to sign something that says you're responsible for any payments that the insurance doesn't cover. Clearly, these payments are the responsibility of the insurance company, but that won't matter to the provider.

If I were in your shoes, I would be calling the insurance company on a daily basis until they paid the provider. I would also calmly be threatening to sue them and their client. If you are persistent, I suspect they will do the right thing.

You said you closed the claim, which I assume means you signed a form freeing them of any future liability. However, it seems you could make the case that you were deceived into thinking they had paid the bill, when, in fact, they only paid part of it.

Also, what about your insurance company? Do you have any sort of uninsured or underinsured coverage? If your insurance company is responsible for any payment, then THEY will contact the other driver on your behalf.

Mahtli69 answered in Insurance about 1 year ago | Report

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"The insurance" you mention above as agreeing to pay = the at-fault person's auto insurance, right? Also; Were the police or courts involved in determining who was at fault?

A: Write the provider explaining that the car insurance company or the individuals insured for the accident will be responsible for any balance remaining. Hopefully you have their address & name from when you took their insurance info? Pass this name and address on to the provider.
(if not, and you only have the name, there are online tools to get the address)

You're not ultimately screwed - in the very worst case scenario you can sue the at-fault person for the costs, as long as they aren't 5 digit costs. Certainly, you should get a lawyer or sign up for the free legal clinic with KCBA.

Rev.Enant answered in Insurance about 1 year ago | Report

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