I have a friend who has been in a minor auto accident. He had some stiches put in his forehead, but was released from the emergency room after about eight hours. His ER bill's now total $23,000 dollars! This does not include the ambulance ride. I'm not sure how his ER bill could be this high for stiches and some test's. Anyway, he says that his medical insurance is now denying his claim. This is not a work comp claim. He was found to be the at fault party in his accident. The party that he rear-ended was not hurt and did not seek medical treatment. My question is....can a medical provider deny treatment for an auto accident and how?? Thank you.
On the one hand your asking if the insurer can deny paying for emergency medical treatment and then at the end of your blurb you ask if a medical provider can deny treatment? Which is it? If it is the insurer, then you need to ask for the basis for their denial. Do you have a copy of your insurance policy? IF not, request one. Did your friend report the accident to his insurer? If not, he needs to do so. Did your friend request med pay benefits from his insurer? If not, he needs to do so. Regardless of whether someone else found it was his fault, does he remember the accident? Does he believe it was his fault? If not, then he needs to retain local counsel with litigation experience to pursue a claim for him.
Your friend should hire an attorney who practices law in the are of personal injury law. There are insurance policies that have language that require the health insurance company to pay the bills where there is no at fault party to collect against. As to health care providers who want to deny treatment if they are not paid. I think they can decide to provide non emergency care if they want to for free or expect payment before they treat.
medical providers are like any other profession. They can agree to provide services or decline to do so. The decision is always with the provider. Sometimes this limits the care available but the ultimate decision is with the provider.
Some health care providers, including hospitals will decline to bill a patient's health insurance if they are aware that the injuries of the patient were that result of an auto accident. Their idea is to get paid the full amount or nearly full amount of the bill from auto liability insurance vs. collecting a much reduced amount form health insurance. Your friend needs to be sure the hospital knows he was at fault and the only insurance available is his health insurance. Yes a medical provider can decline to treat, however there can be severe consequences for a hospital that refuses treatment of ER patients.
Honestly, I think you should let your friend pose his own questions. If I was him, I'd be asking how to get the bill paid, not if a doctor can deny services. A doctor can deny services to anyone who has an inability to pay him for his services.
Your friend should be using his automobile no-fault coverage such as Medical Payments or PIP to cover his car related injuries up to the limit of his coverage. After that, any private health insurance must pay on the bills. If and when private coverage is exhausted, Medicaid or Medicare would pick up if the injured party was covered by Medicare or Medicaid. Perhaps your friend should pay for a brief consultation with a local personal injury attorney for more specific advice.
Legal Disclaimer: If this information has been helpful, please indicate below. Mr. Lundeen is licensed to practice law in Florida and Vermont. The response herein is not legal advice and does not create an attorney/client relationship. The response is in the form of legal education and is intended to provide general information about the matter within the question. Oftentimes the question does not include significant and important facts and timelines that, if known, could significantly change the reply and make it unsuitable. Mr. Lundeen strongly advises the questioner to confer with an attorney in your state in order to ensure proper advice is received.
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