Will Private Health Insurance Cover Medical Bills for My Car Accident Injuries?


An auto accident is a traumatic event that will affect you physically and emotionally. A car crash can turn your life upside down and make things complicated. You may require extensive medical treatment, both immediately following the accident and over the months and years to come. Determining what medical and health insurance to use and what it will cover is complicated enough in normal circumstances. It becomes even more complex following an auto accident.


You may have several insurance policies in place to pay for injuries sustained in a motor vehicle accident: health insurance, medical expenses coverage through your auto insurance (“Med Pay“), and even workers’ compensation. Deciding who will pay for your auto accident injuries is a big decision.


This article explains what you need to know about using your health insurance after a car accident in Virginia. It’s important that you understand the different factors in play so that you don’t end up liable for medical expenses related to your recovery following a car crash.


Meeting Your Deductibles After a Car Crash


Most medical providers, including hospitals, will render necessary treatment following an auto accident. They will then bill your insurance policies for the full value of their charges.


You will have to meet your deductible amount before either insurance policy – Med Pay or health insurance – will start to pay for your medical treatment. The amount of the deductible will vary by insurance policy.


Using Med Pay as the First Line of Defense Against Medical Bills Related to Your Car Accident


If you purchased medical expense coverage as part of your existing auto insurance policy, then your initial medical payments after an accident should be charged through that policy. Medical expense coverage will pay up to a certain amount of medical bills for injuries related to an accident, regardless of fault.


Most Med Pay insurance policies have small limits. The amount of the policy is usually not much when you consider the average costs of required medical treatment after an auto accident.


You may also be responsible for a percentage of the bills until you reach the maximum. Remember to document all out of pocket expenses paid through Med Pay (if you have it), so that you can try to recoup this money through your personal injury claim proceeds.


Should I Use My Personal Health Insurance to Pay Medical Bills After a Motor Vehicle Collision?


After you have exhausted Medical Payments Coverage you should use your personal health insurance to pay for medical costs associated with your injuries from the auto accident.


Using private health insurance after a car wreck is reasonable and beneficial for several reasons:


(1) You have paid premiums for your health insurance, so you should use it;


(2) Your medical expenses will be paid now, which protects your credit rating;


(3) It will ensure that you get the consistent treatment you need for your injuries since many health care providers will not treat you unless you have health insurance. This not only helps you heal faster, it also helps you document your injuries and build the evidence necessary to obtain a full financial recovery; and,


(4) You can receive the proper medical care you require for your auto accident injuries without depleting your finances.


You are required to meet the deductible amount before your health insurance will cover the medical expenses. You may also have to pay co-pays and other expenses required by the health insurer under the terms of your policy.


We recommend asking for and keeping receipts of all co-pays you make at these medical appointments. You should also track your mileage. These are expenses that we will attempt to recover for you when negotiating a personal injury settlement for your car accident.


Do I Have to Pay Back the Health Insurance Company?


Under Virginia law a health insurer is not allowed to assert a lien against their insured’s personal injury claim. This means your health insurance company is prohibited from requiring you to reimburse it for payments made to medical providers on your behalf if you receive payment for those bills from the other driver’s auto insurance company.


The rationale behind this rule is simple: The person whose negligence caused your injuries should not benefit from the fact that you have paid for personal health insurance coverage. Likewise, your health insurance company should not benefit from the fact that the medical treatment for which it paid was someone else’s fault. The Virginia General Assembly recognizes that someone – either you or the insurance company – will benefit from this law. And it has decided that injured persons should receive this benefit.


There are, however, some exceptions that you should be aware of when submitting medical bills from your auto accident through your private health insurance company.


If you receive coverage through a health benefit plan self-funded by your employer, then the health benefit plan may be subject to a federal law known as ERISA. Under ERISA, you may have to reimburse the health benefit plan from the proceeds of your personal injury settlement or verdict. Your health benefit plan may also have a right of subrogation, meaning it can sue the person who caused your injuries for reimbursement for medical bills they have paid related to your auto accident.


Other federal health insurance plans, such as Medicare and Tricare, may assert liens against your auto accident recovery for treatment they paid for. So can Medicaid, which is funded by both the state and federal governments, though it is usually not as aggressive in seeking reimbursement from personal injury claim proceeds as the entirely federal health insurance plans.


Should I Use My Private Health Coverage for Auto Accident Injuries if I’ll Have to Reimburse the Insurer or Health Benefit Plan?


Yes. You should give your health insurance or health plan information to your medical providers, even if you may have to reimburse the insurer or plan from your auto accident claim proceeds. There are good reasons for this:


1. You will not have to reimburse your health benefit plan until your case settles or resolves. Your health insurer or plan will provide the financial help and medical coverage so that you can try to heal.



2. Health insurance companies and health benefit plans contract with medical providers and receive reduced rates. They pay less than you would have to pay the doctor, therapist, or hospital directly. This means it is more beneficial to reimburse the health plan that it is to pay the health care provider directly since you would have to pay a higher rate for the care given.



3. Self-funded health benefit plans are often willing to negotiate a lower amount of reimbursement, which puts more money in your pocket.


Why You Need a Skilled Car Accident Attorney


The auto and health insurance system is complicated and can be intimidating to people who do not deal with every day. Managing your claim may seem impossible, causing you to give up before you receive the compensation you’re entitled to for your injuries or to accept less than you deserve just to be done with the process.


Though it’s common for a health insurance company or health benefit plan to seek reimbursement from your settlement amount, an attorney can help you by not only obtaining a fair settlement but also by identifying who paid your medical expenses and who is entitled to reimbursement. A lawyer can help you address these claims for reimbursement and search for a way to protect you from subrogation.


Your attorney can also negotiate with the health benefit plan and medical providers to reduce the costs of your medical treatment and the reimbursement owed. And if the health benefit plan refuses to treat you fairly. your attorney can go to court and show that the amount being sought by the health benefit plan or medical provider is unreasonable.


By hiring a qualified auto accident attorney in Newport News or Richmond, you can avoid the traps and tricks of the insurance company and obtain the best possible results for your claim. Schedule your free consultation by calling 804-251-1620 or 757-810-5614, or by completing the form to your right