Did You Know That You May Have To Pay Your Health Insurance Back For Auto Collision Injuries?
If you have to use your health insurance to pay medical bills that were due to a car crash, you may be in for a shock. Almost every health insurance policy in Oregon has a clause in it that you are probably not aware of. The clause is usually written in mind-numbing legalese, but the meaning is something like this:
“If you are hurt in a car crash, and you get money for that accident from the person who hit you, then you will have to pay us back for all the medical care that we paid for because of that accident.”
With all the premiums you have been paying for your health insurance, you would think they would have to pay for your medical care when you have been injured. As it turns out, that payment is often just a loan.
We at DuBois Law Group LLC believe that this is a shameful situation that should be corrected. Nonetheless, this is allowed in Oregon. Almost all health insurance policies have this clause written in the contract that you signed when you bought your health insurance policy.
You need to be aware that if you are in an accident and your health insurance pays $20,000 for your medical care for your accident, and then later you get $50,000 from the insurance company of the person who hit you, your health insurance company is going to want their $20,000 back and may have a medical lien against your settlement.
Use Your Personal Injury Protection to Pay Medical Bills
The first step in minimizing the pain from this unfair situation is to use PIP to pay as many medical bills as possible. PIP is better than health insurance for many reasons.
Often, the insurance companies will work out the payment among themselves without involving you. But sometimes they will force you to pay the medical lien.
Your best action is to first try to get them to work it out themselves. Encourage your own insurance company to get reimbursement from the insurance company of the person who hurt you.
You Can Negotiate with the Health Insurance Company – Or Hire a Lawyer to Do This for You
If that doesn’t work, the next best option is to negotiate the amount of the medical liens. Insurers will often reduce the amount you owe them if you negotiate well. For example, if they paid out $130,000 in medical bills, you may be able to talk them into accepting $80,000 or even less in full satisfaction of that money. In this negotiation, ORS 742.536 can be helpful, because it states that the insurance company should automatically reduce its lien by the percentage of your attorney fees and costs, which means that they normally reduce their lien by about 33%.
Even if you don’t have a lawyer, they may still be willing to make this reduction, though they would not be legally obligated to. But be aware that many health insurers believe that because they are nationwide, they do not have to abide by Oregon law. So those insurers may not be willing to automatically reduce the medical liens. But they may still be open to a good argument about why they should reduce the amount they are collecting.
When you are negotiating, just remember, vinegar works, but honey often works better. A strong argument about fairness is often surprisingly effective in getting them to reduce their lien. You may even want to remind them about some of the fine sentiments they probably have on their websites about how their mission is to help people in need.
A good lawyer can often negotiate with your health insurance company and get them to reduce that amount, so that they collect some number less than the full amount they paid. But you are going to have to pay them back, and if you do not negotiate hard, you are going to have to pay them back every penny.