Who Pays Your Medical Bills When a Car Accident Claim Is Pending?

You are taken to the emergency room after a car accident. Over the next few weeks, you see your doctor, have an MRI, start physical therapy, and possibly meet with a specialist.

Then the bills start arriving.

The other driver caused the accident, so their insurance company should pay them, right?

Eventually, the cost of reasonable and necessary medical care caused by the accident may be part of your claim against the responsible driver. But there is an important distinction between who may ultimately be responsible for your damages and who pays your medical providers while your car accident claim is still pending.

In many Missouri car accident cases, the at-fault driver’s liability insurance company does not simply pay each hospital, doctor, therapist, or imaging center as bills arrive.

Instead, medical bills may initially be handled through your health insurance, medical payments coverage on an auto policy, government benefits, payment arrangements with medical providers, or other sources. Then, when the personal injury claim is resolved, the amounts paid or still owed may need to be addressed as part of the settlement process.

That can create a frustrating situation for someone who did nothing to cause the accident.

Understanding how medical bills are handled while a Missouri car accident claim is pending can help you avoid unpleasant surprises later.

Why Doesn’t the Other Driver’s Insurance Just Pay the Bills?

Missouri is generally an at-fault state for car accident claims. If another driver’s negligence causes your injuries, you can pursue compensation from the responsible party for damages that may include medical expenses, lost income, pain and suffering, and other losses.

Ortwerth Law discusses these categories of damages in more detail in its guide to car accident compensation in Missouri.

But liability insurance is not the same thing as health insurance.

The other driver’s bodily injury liability insurer is generally evaluating a claim against its insured. Before resolving that claim, the insurer may investigate who caused the crash, review medical records, determine whether treatment was related to the accident, evaluate the extent of the injuries, and consider the total value of the claim.

That process can take time.

If injuries require months of treatment, the full value of the claim may not even be clear until doctors better understand the person’s recovery and whether future care will be necessary. Meanwhile, hospitals and doctors still expect to be paid. That is where other sources of payment can become important.

Your Health Insurance May Pay Medical Bills First

If you have private health insurance, it may be used to pay accident-related medical expenses while your injury claim is pending, depending on your policy and the circumstances. This can be beneficial because health insurers typically have negotiated rates with hospitals, physicians, and other participating medical providers.

For example, imagine a hospital charges $8,000 for treatment after a crash. Under its contract with your health insurance company, the allowed amount may be considerably lower. The health insurer pays according to the policy, you may be responsible for the applicable deductible, copayment, or coinsurance, and the accident claim continues separately.

Insurance May Be Able to Help While Your Claim is Pending

However, using health insurance does not necessarily mean the issue disappears permanently.

Depending on the type of insurance plan, the insurer may have reimbursement or subrogation rights if you later recover money from the person who caused the accident. In simple terms, an insurer that paid medical expenses caused by someone else may sometimes seek repayment from the eventual recovery. The exact rules can vary significantly depending on the type of health plan, so you should not assume every health insurance reimbursement claim is handled the same way.

What Is Medical Payments Coverage?

Another potential source of payment is medical payments coverage, often called MedPay.

MedPay is optional coverage that may be included in an automobile insurance policy. Unlike the bodily injury liability claim against the other driver, MedPay generally provides coverage for qualifying medical expenses under the terms and limits of your own policy without requiring you to first prove that another driver was at fault.

That can make it particularly useful shortly after an accident.

The Benefits of Medpay for Missouri Residents

Suppose your auto policy includes $5,000 of MedPay coverage. After a collision, you incur emergency room bills and follow-up medical expenses. Depending on your policy, MedPay may be available to cover eligible expenses up to the policy limit while the larger liability claim against the at-fault driver remains unresolved.

Because insurance policies differ, you should review your declarations page and policy or ask your insurance company whether you have medical payments coverage and how a claim should be submitted.

Do not assume you do not have it simply because you do not remember purchasing it.

Can You Use Both Health Insurance and MedPay in Missouri?

Potentially. How the benefits of Medpay in the State of Missouri coordinate will depend on the insurance policies and circumstances involved.

For example, health insurance might process hospital and physician bills while MedPay may be available for qualifying out-of-pocket medical expenses or other covered charges. There can also be reimbursement issues to address later.

The important point is that using available insurance benefits while a car accident claim is pending does not necessarily prevent you from pursuing a personal injury claim against the person who caused the crash. It does mean that careful accounting becomes important.

You need to know what was billed, what was paid, who paid it, what amounts were adjusted or written off, what you personally paid, and whether anyone is claiming a right to reimbursement from a future settlement.

What If You Don’t Have Health Insurance?

This is where the situation can become especially stressful. You were injured because another driver made a mistake, but you do not have health insurance and cannot afford thousands of dollars in treatment. The answer depends heavily on the circumstances.

Some medical providers may establish payment plans. Others may agree under certain circumstances to provide treatment while a personal injury claim is pending and seek payment from a later recovery. Providers may also have potential lien rights under Missouri law.

The availability of these arrangements depends on the provider and should never be assumed. More importantly, do not avoid necessary medical treatment solely because you assume there is no way to handle the bills. If you have been seriously injured and do not have health insurance, speaking with a personal injury attorney early in the process may help you understand what insurance coverage or other options should be investigated.

What Is a Medical Lien?

A medical lien can give a qualifying healthcare provider a legal interest in money recovered through a personal injury claim.

Instead of requiring the entire bill to be paid immediately, a provider may assert a lien against proceeds that are eventually recovered from the responsible party or insurer.

Missouri has specific statutes governing healthcare liens. Sections 430.225 through 430.250 of the Missouri Revised Statutes address liens involving qualifying healthcare practitioners, hospitals, clinics, and other institutions.

These rules can become important when a car accident case settles.

A lien does not simply disappear because the settlement check has arrived.

Ortwerth Law provides a more detailed explanation of this process in its article about medical liens and personal injury settlements in Missouri.

Missouri law also contains limitations affecting how qualifying healthcare liens interact with the proceeds of a claim. For example, Section 430.225 contains rules concerning the distribution of net proceeds when qualifying healthcare liens exceed 50 percent of the amount due to the injured patient.

Because lien issues can directly affect how much money an injured person ultimately receives, they should be identified before a settlement is finalized.

What Happens If Medicare or MO HealthNet Paid the Bills?

Government benefits can create additional reimbursement issues.

If Medicare pays for medical care related to an accident for which another person or insurance company is responsible, federal Medicare Secondary Payer rules can affect the claim. Medicare may make certain conditional payments and later seek reimbursement when responsibility for payment is established.

The federal Centers for Medicare & Medicaid Services provides information about the Medicare recovery process for beneficiaries who receive settlements, judgments, awards, or other payments.

MO HealthNet can also have recovery rights.

Under Section 208.215 of the Missouri Revised Statutes, the state has statutory rights relating to medical payments made when a third party may be liable. Missouri law also provides for a lien on certain money recovered through a settlement or judgment for medical expenses paid by MO HealthNet.

These claims need to be taken seriously.

Settling a personal injury case without identifying applicable government reimbursement obligations can create problems after the settlement.

What If the Hospital Keeps Sending You Bills?

Do not simply throw the bills away because someone else caused the accident. The hospital or medical provider may not have been paid yet, even though you have a valid claim against the other driver.

Review each bill carefully.

Check whether your health insurance information was submitted correctly. If you have MedPay coverage, determine whether the bill should be submitted there. Make sure the provider has accurate insurance information and knows that the treatment resulted from a motor vehicle accident.

Billing mistakes happen.

A provider might not have your current health insurance information. A claim might have been submitted under an incorrect code. Your health insurer may request additional information before processing an accident-related bill.

Keep copies of bills, explanations of benefits, collection notices, receipts, and correspondence.

These records can become important when determining the medical expenses associated with your accident.

Should You Pay a Medical Bill Yourself?

Sometimes an injured person pays deductibles, copays, prescriptions, medical equipment, or other expenses out of pocket while a claim is pending. Keep records of every payment.

A $40 copay might not seem important when you are dealing with a serious injury, but repeated visits can add up. The same is true for prescriptions, therapy, braces, mobility devices, and other accident-related expenses. Out-of-pocket medical costs may be relevant when calculating the damages being sought in your personal injury claim.

Ortwerth Law’s guide to calculating car accident compensation in Missouri discusses medical expenses alongside other losses that can be considered when evaluating a claim.

Good documentation makes those losses easier to establish.

What If the Other Driver’s Insurance Company Offers to Pay Your Medical Bills?

Read any proposed settlement carefully. An insurance company may offer money shortly after an accident, particularly when fault appears relatively clear. Receiving an early offer can sound appealing when bills are already arriving.

But there is an important question to ask:

Does accepting the money settle the entire bodily injury claim?

If the answer is yes, accepting the settlement may mean giving up your right to seek additional compensation later, even if your injuries become more serious than expected.

Imagine you visit an emergency room after an accident and initially believe you suffered only a strained back. The insurance company quickly offers a settlement. Two weeks later, your symptoms become worse. An MRI identifies a more significant injury and your doctor recommends months of treatment.

If you already signed a release settling the entire injury claim, you may have a serious problem.

This is one reason Ortwerth Law recommends considering the full extent of injuries and losses before resolving a claim. Its guide to filing and settling a Missouri car accident claim discusses the broader settlement process.

What Happens to the Medical Bills When the Case Settles?

Settlement is not necessarily the same thing as receiving a check that you can immediately spend in full. Before the client’s portion of a settlement can be finalized, outstanding financial obligations connected to the claim may need to be addressed.

Depending on the case, those could include:

• Healthcare provider liens
• Health insurance reimbursement claims
• Medicare conditional payments
• MO HealthNet claims
• Unpaid medical bills
• Other valid reimbursement obligations

The details can make a substantial difference in the amount an injured person ultimately receives.

For example, suppose a case settles for $100,000. That does not necessarily mean the injured person receives $100,000 after the settlement. Attorney fees and case expenses may need to be deducted if the person was represented by counsel. Valid liens or reimbursement claims may also have to be resolved.

Missouri’s healthcare lien statutes specifically address the relationship between certain provider liens and settlement proceeds. Section 430.225 defines “net proceeds” for purposes of those provisions and sets rules for distributing funds when qualifying provider liens exceed certain amounts.

This is why the amount of a settlement and the amount ultimately received by the injured person are two different numbers.

Can Medical Liens Sometimes Be Negotiated?

Depending on the type of lien, the applicable law, the contract involved, and the facts of the case, there may sometimes be opportunities to challenge, reduce, or negotiate amounts that must be repaid.

It should not be assumed that every bill or reimbursement demand must automatically be paid at the amount initially requested. At the same time, a valid lien should not simply be ignored. Different rules can apply to hospitals, private health insurers, employer-sponsored plans, Medicare, MO HealthNet, and other entities.

That is one reason lien resolution can become an important part of handling a personal injury case, particularly when medical expenses are high compared with the available insurance coverage.

What If the At-Fault Driver Doesn’t Have Enough Insurance?

This can create another problem. Missouri requires motorists to carry minimum levels of liability insurance, but serious injuries can easily result in damages that exceed the available bodily injury limits. A surgery, hospitalization, or lengthy rehabilitation can create medical expenses far beyond a minimum policy.

When damages exceed the at-fault driver’s available coverage, other potential sources of recovery may need to be investigated.

Ortwerth Law discusses this issue in its overview of Missouri auto insurance laws and requirements.

Depending on the facts and the policies involved, uninsured or underinsured motorist coverage may also become important. Additional responsible parties can sometimes exist in commercial vehicle, employment-related, or other accident cases.

The available options depend on the individual accident, which is why identifying all applicable insurance policies can be an important part of investigating a serious injury claim.

Don’t Stop Medical Treatment Just Because the Claim Hasn’t Settled

It can be discouraging to continue receiving treatment while bills accumulate. But stopping medically necessary treatment simply because the liability claim has not yet settled can create two separate problems.

First, it may interfere with your recovery.

Second, an unexplained gap in treatment can later become an issue when the insurance company evaluates your injuries.

An adjuster may ask why someone claiming a serious injury stopped seeing doctors for two months. Sometimes there is a perfectly reasonable answer, such as difficulty obtaining an appointment, loss of health insurance, or inability to afford treatment. Still, it is better to address those issues rather than silently disappearing from medical care. Follow your doctor’s recommendations and communicate about obstacles that are preventing you from receiving treatment.

Keep Track of Every Medical Expense After an Accident

A serious car accident can generate an enormous amount of paperwork. Do not rely on memory. Create a file for documents related to the crash and save medical bills, insurance explanations of benefits, receipts, prescriptions, correspondence, and other records.

You should also document the accident itself. Ortwerth Law’s article on how to document a car accident explains why photographs, police reports, witness information, medical records, and other evidence can become important when pursuing compensation.

Keeping organized records from the beginning can make it much easier to determine what expenses remain unpaid and what amounts may need to be addressed when the claim is resolved.

Talk to a St. Louis Car Accident Lawyer About Your Medical Bills

So, who pays your medical bills while a Missouri car accident claim is pending?

There is no single answer that applies to every case.

Your health insurance may pay some bills. MedPay coverage may be available. Government benefits may cover qualifying treatment. You may pay certain costs yourself. Some providers may assert liens or have other arrangements concerning payment from an eventual settlement.

Meanwhile, the bodily injury claim against the at-fault driver proceeds separately.

The important thing is not to assume that the other driver’s insurance company will simply take care of every bill as it arrives. It often does not work that way.

If you were injured in a car accident in St. Louis or elsewhere in Missouri and are dealing with medical bills, insurance companies, liens, or questions about how you are going to afford treatment, contact Ortwerth Law to discuss your situation.

Understanding who is paying the bills now, who may need to be reimbursed later, and what compensation may be available from the responsible party can be just as important as determining the overall value of the injury claim.