Car accident insurance and hospital bill question?

Asked about 1 year ago - Roseville, CA

I was in a car accident and went to the ER. I had health insurance and made the co-pay of $50. The total ER bill is $25,000. My health insurance paid about $10,000. The ER now put a lien for $15,000 on my claim against the other driver. Is this legal? Shouldn't the ER just bill my health insurance for the entire amount? Why do I have health insurance? I'm lost. It doesn't seem right that the ER can bill my insurance a lesser amount and then come after me for the balance.

Attorney answers (11)

  1. Kristin E. Hobbs

    Contributor Level 13

    18

    Lawyers agree

    Answered . This sounds like an illegal practice called "balance billing." Make sure to retain a personal injury attorney for your accident who is also familiar with insurance issues so they can sort this out. What is not clear is whether you have an HMO or PPO and whether the ER visit was in network. There will be a lien or a right to reimbursement by either your health insurance carrier or the ER, but they are still precluded from balance billing.

  2. Jeffrey Michael Padilla

    Pro

    Contributor Level 13

    17

    Lawyers agree

    Answered . This is a very complex area of law. The Hospital is attempting to "Balance Bill." What is important for you to know is that most reputable insurance companies do not permit balance billing of their insureds. The problem is that the terms are in a contract between the insurance company and your treating facility. It is unlikely that you will ever be provided a copy of that agreement, if one exists. They are guarded like national secrets.

    I suggest contacting your insurance company and let them know what the hospital is doing. If you don't have a copy of your own policy have them provide you one. Make sure it is the complete policy. You then need to review it and see what it says for emergency coverage. There is a chance you could point out to your insurance company that you have paid for indemnification from emergency bills like this and they are in breach if they haven't properly protected you from this exposure. If nothing else, that may get their attention and force them to provide you with a clear understanding of the relationship they have with the hospital in question.

    Sorry I couldn't provide anything more concrete, but like I said, this is a very complex area of law.

    Good luck!

    This response applies to California Law only and does not create any legal relationship between the attorney and... more
  3. Robert Max Klein

    Pro

    Contributor Level 15

    14

    Lawyers agree

    Answered . This has become a very complicated area of law. Sadly, the victims of an injury often come up on the short end and insurance carriers (whether auto insurance or health insurance) come out much better. The answer to your question depends on several factors: what does your health insurance cover, what does your policy state, does the hospital have a contract with your health insurance, is this a balanced billing issue, can the hospital assert a lien pursuant to CA Civil Code sections 3045.1 and related sections. I would suggest meeting a lawyer in your area who can represent for the injuries you sustained in the collision.

  4. Alan Ray Barnes

    Contributor Level 19

    12

    Lawyers agree

    Answered . In 2009 the California Supreme Court held that "balance billing" for emergency medical services is illegal. (Prospect Medical Group, Inc. v. Northridge Emergency Medical Group.) Hospitals have been attempting to avoid this rule ever since, and balance billing is once again becoming more prevalent. You need to retain competent counsel to likely contest the hospital's alleged lien.

  5. Robert Bruce Kopelson

    Contributor Level 20

    12

    Lawyers agree

    Answered . It depends upon the health insurance plan you have. If the plan only covers certain things, the hospital may be able to balance bill. If the portion they are seeking form you is the deductible or non covered items, they can do this. Talk to an atty to review the plan and the situation.

  6. Christopher John Gansen

    Contributor Level 19

    8

    Lawyers agree

    Answered . It's likely not legal. You should consult a local lawyer.

  7. William West Seegmiller

    Contributor Level 10

    8

    Lawyers agree

    Answered . My answer to you is it depends. An experienced personal injury attorney will be able to go over all your medical bills and seek to resolve this on your behalf.

  8. Christian K. Lassen II

    Pro

    Contributor Level 20

    8

    Lawyers agree

    Answered . Have your lawyer resolve it

  9. Joseph Torri

    Pro

    Contributor Level 17

    4

    Lawyers agree

    Answered . I agree with my colleagues. Seek the assistance from a lawyer on this matter.

    This communication does not create an attorney-client relationship. This means that I am not your lawyer and I... more
  10. Nareg Sarkis Kitsinian

    Contributor Level 8

    1

    Lawyer agrees

    Answered . As my colleagues have stated, this practice is likely illegal. The hospital has an incentive to put a lien on your case because it would likely recover more than actually billing the insurance for the treatment provided. However, the legality of the hospital's practices depend on our actual health insurance coverage and policy. An experienced attorney can review your insurance coverage and advise the appropriate course of action.

  11. Joseph Barnet Weinberger

    Contributor Level 3

    1

    Lawyer agrees

    Answered . With all due respect to the prior responses, I believe that they may have missed the point. In the Parnell decision the court held that a medical facility may include terms in their contract which permits the facility to make a claim for the balance of their bill over and above what is paid for by insurance if the patient makes a recovery from a third party. This area of the law can be very complicated and you are best served by speaking with an attorney who is well versed in this area and has the ability to reduce and/or eliminate this obligation.

    Please feel free to contact me and I would be happy to provide you with a more detailed response.

Related Topics

Personal injury

If you suffer a personal injury as the result of the actions or negligence of another, you may seek financial compensation for physical or emotional damages.

Personal injury settlement

Personal injury settlements are agreements made between the two parties of an injury lawsuit. They outline the compensation that an injured party receives.

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