QuestionAbout 2 months ago, I was on a run and was hit by a car. I was in the sidewalk and it was daylight - the driver did not look before turning. I got very lucky and didn't break anything or need any major surgeries, but I have medical bills from the doctor visit. All in all, I have a sprained hip and some serious bone bruising. However, the problem with my hip has only gotten worse and now my back is also very painful. I did not miss any work but am on my feet all day for both jobs I work. Overall I am in a lot of pain daily. The man who hit me is very sorry and his car insurance is handling the claim.
I have 2 questions:
1) The bill from the doctor was $850, but to my amazement my insurance paid $600 of it even though I hadn't met my deductible (they called it a discounted rate?). Am I eligible for the $250 in compensation or the $850? Or more? And what documents do I send to his insurance when they ask for how much the bills were?
2) The doctor said I should have made a full recovery by now but it's only getting worse. I am going to start chiropractic/physical therapy. If that is ongoing, how am I compensated - just for the copay I am charged or the full amount of the services (whether or not my insurance pays it)? And what if it doesn't get better, do they just estimate the amount of treatment they think I will need in the months/years ahead?
Thank you so much for your help!!
Crystal
AnswerCrystal,
1. You can get the $250.00 as compensation, but you will use the $850.00 to calculate total bills for pain and suffering review. When they ask how much were the bills, you say $850.00 and show them the proof, if they pay it to you, you are supposed to pay back the health insurance or car insurance that paid for it already (unless it was PIP or MED PAY, conditions and exceptions apply here, so there is no easy answer).
2. Provided your medical doctor referred you for therapy, then normally a maximum of about 12 weeks of visits at a maximum of three times per week will be allowed if you are improving the whole time. If you're going against doctors orders or without, then you may have a problem with the therapy being "necessary". You're responsible for the full amount of the bills at the chiropractor so keep track of the full amount and what you have paid. Anything you pay out of your pocket you can request as a reimbursement, and in most cases the doctor will have a lien on services they provide so when the insurance pays, the doctor's name will be on the check and you'll get whatever is left over the outstanding bills (this is the simple answer). You'll have to find a therapist or chiro that will treat you and bill it out for you because the insurance company for the at fault person (not yours) will not settle your claim until you have finished medical treatment (in most cases). On the last part of #2, regarding if it doesn't get better, then you are exactly right, they will need to calculate the level of future medical you may need or compensate you for a lifetime of pain and suffering.
I hope this helps! Information is always free at Petty Details, LLC!
