How to Get Medical Bills Paid After an Automobile Collision in Washington State
When you have had the misfortune of being injured in an automobile collision, then you will potentially have to deal with multiple different types of insurance coverage. If you have been injured and you want to get medical attention, how will you get your bills paid?
Personal Injury Protection (PIP)The best insurance for payment of medical expenses in full is personal injury protection (PIP) insurance coverage. PIP is optional insurance coverage that is added to an auto policy. In the event of a collision, regardless of who is at fault, PIP will help pay for medical expenses, wage loss, and loss of essential services. The minimum amount of PIP medical expense coverage in Washington is $10,000. Policies can be purchased that provide coverage of $25,000, $35,000, or even more.
PIP in Washington is not mandatory. Although car owners do not have to buy PIP, their insurance company must offer the coverage. RCW 48.22.085 provides that no new automobile liability insurance policy or renewal of an existing policy may be issued unless PIP coverage is offered as an optional coverage. The law states that a named insured may reject, in writing, PIP coverage. The insurance carrier is not required to include PIP coverage in any supplemental, renewal, or replacement policy unless a named insured subsequently requests such coverage in writing.
PIP also helps in that you avoid deductibles, co-pays, and limited referral networks, and in most cases should cover medical bills in full, as they are incurred. When PIP is available, health care providers should promptly submit records and bills to the PIP insurance carrier, be available to answer questions from the PIP adjuster, and make sure all submitted records are legible, organized, and properly coded.
You can learn more about PIP coverage in Washington by visiting the Washington State Insurance Commissioner's website: https://www.insurance.wa.gov/your-insurance/auto-insurance/personal-injury-protection/
Health Insurance CoverageMany times, the minimum PIP coverage of $10,000 exhausts before you reach maximum medical improvement and get released from care by your primary doctor. This is especially true where you are taken by ambulance from the collision scene to a hospital for emergency care. Other times, you may have no PIP coverage available. In either situation, the primary insurance for immediate payment of medical expenses is any available health insurance. Most Washington health plans will cover chiropractic care, massage therapy, physical therapy, and acupuncture pursuant to WAC 284-43.
Billing health insurance is subject to the terms of any contract that the health care provider has with the particular health plan. This means that there may be limitations on the number of treatment visits and covered conditions. You may need to obtain referrals for care, and deductibles and co-payments will apply.
Worker's Compensation Coverage (Labor & Industries or Self-Insured Entity)When are injured on-the-job because of a motor vehicle collision, the primary insurance coverage for payment of medical expenses is usually worker's compensation coverage through the Washington Department of Labor & Industries, or a Self-Insured Entity. While health care providers who treat injured workers are entitled to receive payment in full for their services, payments on L&I claims are controlled by Washington statutes (RCW) and administrative codes (WAC).
Pursuant to RCW 51.28.020(1)(b), a health care provider is obligated to inform you, as an injured worker, of your right to L&I benefits, and to provide "all necessary assistance" in completing an application for benefits. This obligation must be fulfilled without charge to the patient, and health care providers are then required to bill all services for an accepted condition, at a usual and customary fee, to the L&I claim. In the event that a provider's bills to the public are lower than the Department's fee schedule, then WAC 296-20-010(2) states that the Department will pay the lesser of the two.
No PIP or Health Insurance Coverage - Liability Insurance OnlyIf you do not have PIP coverage, health insurance or worker's compensation insurance that will cover your medical bills, you can seek medical care and asked that the health care provider "hold" their bills through use of a medical lien against any future settlement with the person that caused your injury. A medical lien can be filed when there is a third-party responsible for your injuries, and when you have outstanding medical bills because PIP coverage exhausted, or there was no PIP, worker's compensation, or health insurance available. In such cases, a health care provider can hold your medical bills for payment from any settlement with the at-fault party's liability insurance carrier. Medical liens are governed by RCW 60.44.
By asking any health care provider to file a medical lien, the provider has the right to enforce the lien against any final settlement of your claims with the insurance company for the at-fault party. You should monitor how much you owe for the treatment you are receiving so that you are not surprised by a big outstanding bill that might make settlement of your claim difficult.