If you've been injured in a Massachusetts car accident, you will certainly have medical bills to pay and a frequent question we get is, "who pays for those medical bills?"
Medical bill payment and the amount paid are dependent on whether you have private health insurance, such as Blue Cross, Tufts, or Cigna, or if you do not have private health insurance, such as MassHealth or an ERISA-based plan.
If You Have Private Health Insurance:
If you have a private health insurance plan in Massachusetts, your car accident-related medical expenses will be covered by your automobile insurance policy (or the policy for the car you were in at the time of the accident) up to the first $2,000 in “reasonable and necessary” medical expenses.
Related bills over $2,000 will be submitted to (and presumably paid by) your private health insurance plan. Amounts paid by your health insurer may have to be repaid if you are successful in recovering money from the at-fault party. This is because your health insurer most likely has a right to "subrogation" which simply means they have the right to be paid back IF you recover money for these expenses from someone else.
But it is important to note that the amount to be paid back should have been included by your lawyer when valuing and negotiating your claim so that any settlement takes into account your obligation for repayment.
If you do not ultimately recover money from the at-fault party, then you do not have to repay your health insurance company anything.
If You DO NOT Have Private Health Insurance:
If you do not have a private health insurance plan in Massachusetts (or if you have MassHealth or an ERISA-based plan) your medical bills will be paid by your automobile insurance company up to a maximum of $8,000.
Now, if you do not have private health insurance and you have medical expenses that exceed the $8,000 that you obtained or could have obtained from your PIP insurance benefits, you will have an outstanding balance to the medical providers for the amount over and above the $8,000.
Just like you had an obligation to pay your private health insurance company back under the right of subrogation, you similarly will have an obligation to pay the medical providers who provided you treatment but have not yet been paid. The balances owed them may also come out of your settlement or award if, in fact, you receive one.
Most experienced injury attorneys will negotiate the balances owed to medical providers and attempt to get the balances reduced so that you may net more of the settlement proceeds. I can tell you from experience that getting a medical provider (doctor, physical therapist, etc,) to take less than what they are owed is much easier to do than getting a health (Blue Cross, Tufts, Cigna, etc.) plan to do so.
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As Massachusetts car accident attorneys, we know the unfortunate truth: a car accident is inevitable.
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