Is your Virginia healthcare provider refusing to accept your health insurance because you were hurt in a car accident? Read this...

An issue that arises more often than I would like is accident victims telling me that their doctor, physical therapist (or other Virginia health care provider) won’t accept their health insurance because they were in a “car accident.” Therefore, they are required to use their car insurance.   

If you’ve encountered this situation, you need to do a couple things:

  • First – make sure that the healthcare provider is an approved health care provider under your health insurance. If they are an “in-network” provider, they have agreed with your health insurance company to accept you as a patient and accept your health insurance payment. (Note - If the provider is not an “in-network” provider, then call your health insurance company and get a list of providers that are in-network. And go to an in-network provider). 
  • Second – read Virginia Code Section 8.01-275. Under this law, your in-network provider is required to submit their bills to your health insurance.Otherwise, they risk not getting paid at all. 
  • Third – call the health care providers and (respectfully) remind them that it’s your understanding that they are required to submit your bills to your health insurance company for payment. You can also provide them a copy Virginia Code Section 8.01-27.5. If they still refuse to put submit your bills to your health insurance, (respectfully) request that they put their denial in writing to you. 

This should compel any respectable in-network health care provider to follow the law and submit your bills to the health insurance company. If they continue to refuse to do so, you can report them to your health insurance company (as I’m sure they’d like to know one of their providers seeks to not live up to their end of their agreement). 

Why would Virginia Health Care Provider prefer my car insurance pay my bills rather than my health insurance? (Hint - it's all about the money).

Remember, medical billing is pretty complicated. But in reality, it’s a simple answer – it’s all about the money. 

By agreeing to be an in-network provider, a health care provider is agreeing to see patients at a discounted rate. So for example, if an orthopedist generally charges $250 for an office visit with a patient, if the orthopedist accepts their health insurance, they will typically only be paid (for example) 50%, or $125. 

If, however, that same health care provider is able to get paid by the patients car insurance (assuming the patient has car insurance), they will get paid for 100% of the bill, or $250. So, you can see that the providers have a tangible incentive to get money from your car insurance rather than your health insurance. 

I’ve heard I have to pay my health insurance back anyway. What’s the difference to me which insurance company pays?

Assuming you do have to reimburse your health insurer (which may or may not be required – it really depends on the type of health insurance you have), you’re still in a better position than you would have been if you just paid the bills with your car insurance. There’s several not so readily apparent reasons for this:

  1. Car accident claims take a long time, you don’t want to screw up your credit score. To properly prosecute a personal injury claim in Virginia (at least for complex injuries), it can take several months (to years) to actually get paid. During that time, your health care providers will want to be paid. And if they don’t get paid, they may submit your bills to collections. By having your health insurance pay the bills, you don’t have to worry about your credit getting messed up.
  2. You end up with more money in your pocket. As I said above, when your health insurance pays your medical bills, it’s generally at a discounted rate (say 40% for example).  In the event that you have to reimburse the health insurance company, it will only be at that discounted rate. However, if you pay the bills with your car insurance money, you’re paying the bills at a rate of 100%. So, while the health care provider gets more money, you lose it.
  3. You paid for your health insurance policy, why shouldn’t you be able to use use? Think about it, you’ve been paying your premiums for how many months (or years).  There’s nothing in your contract (unless they can show you otherwise) that excludes payments for car accidents. Don’t let them change the agreement when you need your insurance the most. 

Conclusion

Look, I get it, they are health care providers – they must know what they are doing. Who are you? Just a lowly patient. Here’s the problem – they may be taking advantage of your lack of knowledge. Remember, you have a right to speak up. Of course, always be respectful. But don’t be pushed around.

James S. Abrenio
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Focusing on criminal, traffic defense and personal injury cases