I understand that there is significant debate about Obamacare, whether it is fair and right, whether it will work, and whether it will lower or raise health care costs in this country. It is not my purpose in this article to take sides in this sincere and important debate. I'm an attorney, not a legislator. It is not my job to write the law, rather, it is my job to help my clients understand it, and how it may affect their personal injury accident case. One of my great passions in life, and the purpose of my blog, is to help my neighbors here in Houston and throughout Texas understand the law and the impact it may have on their lives. I love to give information, because information is power, and nothing is better for a robust legal system than informed and empowered citizens.
I'm Feeling Better Now, But What If Things Get Worse?
You've probably heard by now that Obamacare requires insurance companies to provide health insurance coverage to individuals regardless of any pre-existing conditions, and to provide full coverage for those pre-existing conditions. One common concern among my personal injury clients when their cases are resolved is what will happen if they suffer a "flare up" of their injury. Texas law allows recovery for future medical care in a personal injury claim. When appropriate, I always make sure that the claims I make for my clients include appropriate amounts to cover any future medical expenses they may incur as a result of their injuries. Unfortunately, it is sometimes difficult or impossible to accurately predict the amount of future medical care that may be needed. Now my clients can rest assured that, no matter what happens with their health or the status of their injuries, their future problems will be treated under any health insurance policy they get in the future.
What If I Don't Have Any Health Insurance At All?
Another example of the effects of Obamacare on a personal injury accident claim: Any hospital that is a 501(c)(3) charitable hospital is now required under Obamacare to "limits amounts charged for emergency or other medically necessary care provided to individuals eligible for assistance under the financial assistance policy . . . to not more than the amounts generally billed to individuals who have insurance covering such care." This Federal code provision basically means that if a charitable hospital provides emergency or other care to someone who is uninsured, they are required to bill that individual no more than that which would be paid on behalf of someone who has health insurance. In the past, those treated in a hospital emergency room without health insurance may face bills many times higher than those with insurance. This provision will help limit this problem in the future.
What If I Suffered Catastrophic Injuries?
Going back to the questions about what will happen to a seriously injured client in the future, many of my personal injury clients have suffered catastrophic injuries in car crash or other accident that may require a lifetime of monitoring and medical care. While I make every effort to insure that my clients will be well taken care of for the rest of their lives, that lingering question may always remain: "What if . . ?" Well, the good news is that this question now has an answer. Under The Affordable Care Act, lifetime limits, or "caps," on spending for essential medical services are now lifted. When I do my part to make sure that sufficient amounts are recovered for future medical care, any lingering concerns about sufficiency can now be limited by this provision of Obamacare.
Q: Is There A Catch?
So far, it appears that Obamacare will have a generally positive effect on my personal injury clients living in Houston and throughout Texas. There is one aspect of this law, however, that does cause me some concern in regard to my clients' personal injury and accident claims. Since the major tort reform laws were passed in Texas in 2003, Texas Civil Practices and Remedies Code ?41.0105 has mandated that "recovery of medical or health care expenses incurred is limited to the amount actually paid or incurred by or on behalf of the claimant." What has this meant for my personal injury clients in Houston and Texas? Well, simply put, when one of my injured clients has health insurance, this Texas law prevents us personal injury lawyers from recovering as medical expenses anything greater than the sum total of what was paid by the health insurance company plus any co-pay or deductible owed by the client.
Given this limitation of the Affordable Care Act, plus the effect of the individual mandate, my nightmare scenario as in making a personal injury claim is as follows: My client is injured in a car accident in Houston, is transported to a "for profit" hospital, and walks out with a medical bill of $50,000.00. If that client does not have health insurance, despite the federal mandate requiring coverage, what is to prevent an unscrupulous auto insurance company (and believe me, there are plenty of those in Texas!) from only agreeing to pay what the hospital would have been paid, had my client followed federal law and had health insurance coverage? This amount could end up being far less than the bill my client is actually required to pay! While this is a fight I would fight to the end to win on behalf of my personal injury client, it is a fight I would not have had to consider facing, absent the effects of Obamacare.
We Will Have To See
The long term effects of Obamacare on personal injury claims in Texas will become more clear in coming years. In the meantime, if you have a personal injury claim and have (or expect to have) substantial medical bills, you should seek the advice of an experienced personal injury attorney.
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