By: Teresa W. Gipson | Ansbacher Law
It makes sense that if I’m injured in an automobile crash, car insurance should pay my medical bills – right? Well, not exactly. Florida is a “no-fault” state; meaning everyone in Florida who owns an operational motor vehicle must carry their own personal injury protection (PIP) insurance to cover the first $10,000 in medical bills should they be involved in an accident – no matter who is at fault in causing the accident. This is really a great provision under Florida law. Often, it takes days, weeks, months or even years to determine fault for a contested liability accident. This way, everyone gets immediate emergency medical care following a collision, while liability is still being determined.
But $10,000 does not go very far after an emergency room visit. What happens when the $10,000 in PIP is exhausted and you are still treating for your injuries? That is when the next layer of coverage kicks in – your personal health insurance. Once PIP is exhausted, an “exhaust letter” is issued to any medical provider who has billed PIP for covered charges. The medical providers must have your health insurance on file so they can immediately and timely file for coverage under your health insurance. If your medical providers do not have your health insurance available, they may place a lien against any recovery you eventually receive from your settlement with the at-fault driver.
Why is this important? It is important because filing with health insurance greatly reduces the amount of medical charges you must pay out of any settlement proceeds you may receive from the at-fault driver. Health insurers have contracts with medical providers (always be sure any doctor or provider you see is on your health insurance plan) which dictate the amount the provider can charge their insured patients for specific services. Consider these examples:
- An imaging facility charges $1,500 for an MRI. However, under the health insurance contract, it may charge the insured $250.00. Therefore, the amount you, as an insured under the health insurance contract, have to pay out of any settlement you receive, is $250.00, owed to the health insurance provider.
- An imaging facility charges $1,500 for an MRI. The imaging facility does not file with health insurance. The amount you owe from any settlement you receive is $1,500, owed to the imaging facility.
All of this can be overwhelming, especially when you are in pain following a collision. Ansbacher Law is here to help you navigate through post-accident problems by offering sound, experienced legal counsel.
About the author. Teresa W. Gipson is a paralegal at Ansbacher Law. She is the senior case manager of the personal injury team. Ms. Gipson has more than 30 years of personal injury and litigation experience. She is recognized as a Florida Registered Paralegal by the Florida Bar.