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Health Insurance or Car Insurance: Who Pays for Medical Costs?

by | Jul 15, 2023 | Uncategorized |

Suffering an injury in a car accident delivers a double blow: the shock of the injury itself and the financial shock of sudden medical bills. As you’re listening to the doctor explaining the details of your injury and required treatment, you’re no doubt wondering how you’re going to pay for it all. Before searching online for a “car accident lawyer near me,” consider an overview of who’s likely to pay your medical expenses in San Antonio.


Health Insurance or Car Insurance: Who Pays for Medical Costs?

As Texas is an at-fault state, the driver responsible for the accident is legally liable for the other driver’s medical bills. So if another driver caused your injury, you may be able to file a claim with their auto insurance. If the other driver’s insurer refuses to pay your medical bills and other damages in full, you may also file a lawsuit against them.

This is often an effective route to compensation for your medical bills and other losses. But there’s one significant factor to bear in mind: recovering money from the other driver’s insurer takes time. It will take a few months at the very least, and sometimes over a year before you see a single cent of that money. In the meantime, you may have to turn to your own car and health insurance providers to pay for your hospital bills.


Your Car Insurance Will Typically Pay First

When more than one of your insurers provides coverage for your immediate medical costs, the order in which they pay is based on the coordination of benefits rules. The coordination of benefits determines which insurer is the primary payer and which is the secondary payer. In most cases, with an automobile accident, your car accident insurance provider will be considered the primary payer.

This means your medical bills will initially be paid by the Personal Injury Protection (PIP) or MedPay coverage included in your car insurance. Once you’ve reached their limits of healthcare coverage, your health insurance provider may then step in to cover the rest of your medical bills. In some circumstances, you might arrange a lien with your health insurer that would allow them to recover their money out of any settlement you later receive from the at-fault driver’s insurance.


Filing a Claim With Your PIP or MedPay Insurance

PIP insurance is the component of a car insurance plan that covers your medical costs resulting from an accident. To a limited degree, your PIP coverage may also cover lost wages and some other damages. In Texas, PIP is a mandatory inclusion in car insurance policies unless you specifically signed a PIP waiver when signing up with your insurer. Most drivers opt for $5,000 or $10,000 of PIP coverage when they sign up.

PIP is no-fault insurance, meaning you can claim PIP coverage even if you were responsible for the accident. This makes PIP a reliable go-to option for many car accident victims to deal with their immediate medical bills. Medical Payments Coverage (MedPay) is an alternative to PIP, which also serves as an add-on to car insurance. MedPay typically offers relatively limited payouts of up to $2,500 for medical expenses.


Filing a Claim With Your Health Insurance

If you were in a serious collision, your medical bills are likely to exceed the PIP or MedPay limits in your car insurance policy. After suffering a catastrophic injury, your ongoing medical treatment may reach tens of thousands, if not hundreds of thousands of dollars. This is where your health insurance will often come into play.

You provide your healthcare provider with both your car insurance and your health insurance policy details. The adjusters of both insurers would then work things out, usually arranging for your car insurer to pay first and then your health insurer to cover the balance. As each individual’s situation is different, it’s important to speak to a car accident attorney who can study your insurance policies and help you file each claim, including the claim with the other driver’s insurance provider.


Deferring Payment With Healthcare Providers in San Antonio

There is another potential option with regard to your immediate medical bills. If you have a strong legal case against the other driver and an attorney has agreed to represent you, some local healthcare providers may agree to treat you on a deferred payment basis. This would usually involve enacting a lien on your final settlement when it eventually arrives: this means your doctor would receive a portion of the money you receive from the at-fault driver.

With a medical lien, your doctor is effectively working on a contingency fee basis, much like your attorney. This kind of arrangement can be a godsend for an injured accident victim that’s struggling to meet high medical bills. When you hire an experienced local car accident attorney, they may be able to help you negotiate such arrangements with healthcare practitioners they know in San Antonio.


Can a Car Accident Lawyer Near Me Help Find Medical Care?

This is a common question asked by accident victims. When you’re dealing with a serious injury that involves complex, specialist medical treatment, it can be difficult to know where to turn. A local attorney may be able to offer the guidance you need, not only with regard to your legal rights and financial recovery, but also relating to the recovery of your health.

When you consult with an attorney soon after your accident, they can use their database of medical professionals throughout the region to help find you suitable medical care. One often overlooked benefit of car accident attorneys is how many medical experts they work with on a daily basis in retaining expert witness testimony and helping their clients find treatment.


Your Attorney Can Negotiate on Your Behalf

Insurance companies are naturally unwilling to lose money and often look for reasons to deny or at least minimize the value of a claim. This goes for the insurer of the at-fault driver and also for your own car and health insurance providers. It’s important to bear this in mind when filing a claim and communicating with any insurance adjuster. Insurance adjusters may appear courteous and helpful in person, but always remember they’re not on your side.

It’s usually advisable to have an experienced attorney file your claim and communicate with the insurance adjuster on your behalf. Attorneys can use their experience and legal expertise to prove the validity of your claim and negotiate the highest possible payout.


Finding Coverage for Future Medical Expenses

It’s especially important to find a car accident lawyer when your injuries are serious and your damages are significant. The higher the required payout, the harder insurers tend to resist paying a full and fair figure. Following a minor car accident, medical treatment is often completed by the time you file your claim with the at-fault driver’s insurer.

But when a serious or catastrophic injury is involved, ongoing medical treatment might be necessary for years or decades to come. In these extreme situations, you need to take great care when dealing with insurance companies. If you make a mistake and give the adjuster an excuse to deny or reduce your damages, you may later find your money running out before your medical bills do.

Contact Gamez Law Firm today at 210-951-2024 to have a highly experienced car accident lawyer fight on your behalf for fair compensation. We’ve been helping local residents of San Antonio fully recover from their accidents since 1973.