Why Do I Need Health Insurance if I Have Car Insurance?


Many of my clients are surprised to learn that the insurance company which insures the driver who hit them won’t immediately pay for their medical care after their accident. Instead, my clients have to go through a claims process to prove that the medical treatment they received after their accident was solely related to that accident. My clients are also surprised to learn that their medical bills are not paid as they come in but instead, they have to wait until their treatment is completed. Only then can I negotiate a settlement that will hopefully compensate them for past bills, outstanding balances, injuries they sustained, pain and suffering, lost wages, etc.

People can of course disagree about health insurance reform but one of the great things about the Affordable Care Act (ACA) or, “Obamacare” is that you are not penalized for having a preexisting condition. Therefore, if you are injured in a car crash and tear a ligament that requires a surgical repair, you can purchase health insurance and still be covered for a future operation.

If you buy health insurance after a crash, it won’t pay for bills incurred before buying health insurance, but it will help you with the ongoing treatment you need. Before the ACA was enacted, many of my clients were left out in the cold, having to pay for the medical treatment they needed because of their accident. Before the ACA, health insurance companies would not cover them for the injuries they sustained in a car crash.

Ultimately, the process of recovering from an auto accident claim with a car insurance company is both difficult and imperfect. Often people are not able to get the treatment they desperately need right away without underlying health insurance.

Will not having health insurance negatively affect your auto accident claim and the type of treatment you can get after a car crash?

The answer, unfortunately, is yes, and it will affect your claim in a number of ways:

  1. If you don’t have or get health insurance during the claims process, you could be stuck with a large medical bill that will ultimately reduce the amount you receive after your case is settled. When your case is settled with the at-fault party’s insurance, under the law, you have to pay back your health insurance company out of the settlement amount for a portion of the money they paid for medical bills related to the accident. The good thing about health insurance is that they pay a discounted rate on any treatment you receive, so having health insurance will allow you to yield a greater amount from your settlement.
  2. Like any other business, doctors and medical facilities would like to assure that they are paid for the services they provide. Unfortunately, there are a lot of doctors who will not see patients who do not have health insurance for fear those patients will not pay for their treatments. This is especially true when it comes to surgeries. Surgery is a particularly large expenditure so a lot of medical facilities will turn away those willing to pay out of pocket, simply because they are more comfortable dealing with patients who have health insurance.
  3. If you get treated at an emergency center or if you are taken to the hospital in an ambulance and you don’t have health insurance, you will have an outstanding balance with the hospital, treating doctors, and if you get x-rayed, the radiologist. This is after your car insurance pays the first 80% of your medical bills. If you are unable to pay those outstanding balances, some facilities will inevitably send your bill to collections, which will negatively affect your credit. In the best case scenario, you may be able to call the medical facility to work out a payment plan before your bill goes to collections.
  • Some doctors will work with your attorney and send a Letter of Protection, which says that the doctor will defer collecting outstanding balances until your case is settled. However, a lot of doctors are not open to this option because there is still a risk they won’t get paid in the event your case doesn’t produce a settlement. They also risk getting paid less than the outstanding balance if the settlement amount is too small.
  • Another problem can occur when the doctor, most likely a surgeon, accepts a Letter of Protection, but the surgery center or the anesthesiologist does not. Unfortunately, Letters of Protection can also be used by defense attorneys in trial to suggest that a surgeon’s testimony is biased because the surgeon may not get paid unless her testimony helps the case.
  1. Even if you have health insurance or you buy insurance after your car accident, your health insurance company- or the type of coverage you have- could affect the kind of medical treatment you receive. I had a client who had health insurance through her job and even though she worked in Tallahassee, her job was based in Miami. Unfortunately, no doctors accepted her coverage in Tallahassee, even though the same coverage would’ve worked fine with doctors in Miami. My client had to resort to traveling to another city to seek treatment.

You should also be aware of the copays that come with your health insurance. Some insurance plans can leave you with overwhelming copays you may be unable to afford.

Ultimately, the value of your auto accident case is mostly tied to the nature of your injuries and the type of treatment you receive. I have seen car insurance companies dig their heels in, and refuse to pay for future treatment a client may need. Their argument is that they don’t want to pay for a procedure that may or may not happen. Even if your doctor says that you will need a surgery and the only reason you can’t get it is because you don’t have health insurance, car insurance companies may still refuse to pay for that surgery. In these instances, your attorney may choose to take your case to trial. Unfortunately, cases that go to trial may take months to years to resolve, all the while you are going without treatment. You also run the risk of the jury siding with the car insurance company over you.

In the end, health insurance before a crash is exactly that; insurance for when things go wrong. After a crash, the question is no longer, “What if I get hurt?” Instead, it’s “I am hurt, how do I pay for the treatment I need?” You don’t want to have to worry about getting the treatment you need.

If you are injured in a car accident, please call an experienced attorney! One of the experienced attorneys at Fasig & Brooks can help you go over all of your options and come up with a plan that gets you the treatment and compensation you need and deserve.