QuestionFirst, thank you in advance for your time!
Last July(2010), my family(husband and 2 kids) and I were involved in a rear end collision. It was obvious it was the other party's fault since we were sitting still at an off-ramp of a highway at the yield sign, waiting for traffic to clear and got hit from behind. A police report was made and the other driver got the ticket. My husband had to go to his PCP for a lingering headache the day after the accident. He is also a post-stroke patient...not sure if that matters in anyway. The only other medical care received by any of us was to go to the chiropractor. My oldest son has an anxiety disorder, and he did have to see his psychologist about the accident, as it prompted some weird OCD issues to pop out with him, and she(the psychologist# concurred that these acute issues were probably caused from this, as they were not present in this way prior to the incident. She documented it and sent it to the adjustor.
Our medpay kicked in as soon as we filled out the papers for it, and the chiropractor and PCP were paid before the end of 2010.
Also, we live in Missouri, and it is my understanding that there are some odd laws here about auto accidents....I know there is no subrogation in regards to any kind of medical payments for the insurance companies, and there is also a double-dip policy so to speak, about reclaiming from the at-fault party's insurance what my medpay paid out. Correct me if I'm wrong on any of this information...it's all new to me.
In dealing with their insurance, I have 3 issues...
First issue... The adjustor stated that the chiropractor that we saw stated he would accept a lesser settlement offer and so they are not willing to pay out anymore than that #which is about 1/2 of what was billed by the chiropractor and our medpay actually paid). In speaking with the chiropractor, he stated that was not the case, and only referenced that IF he was to not get paid for an outstanding period of time, that only then would he consider such a thing. Plus, there's nothing in writing about it, so really, it didn't happen. When the medpay sent him the checks, he called the adjustor to inform her of this, which was well before I spoke with her about it. So she had full knowledge of how much was paid, and that it wasn't a lesser amount. Considering the laws in Missouri, don't they have to pay that money out since there was no agreement, nothing in writing, and our medpay verifies what was paid out was the full amount billed by the chiropractor?
Second issue...Their insurance is giving me a lot of problems paying the psychologist bill, which to a degree, I can understand. That's not a normal thing associated with an auto accident. However, it's documented that my son has an anxiety disorder that, before the wreck, was under control...and after, was not and some strange behaviors were present. They are not wanting to give him but $75 more in p&s than my younger child that had no other issues than to see the chiropractor. This doesn't seem right.
Third issue... The adjustor from their insurance has on several occasions called up our chiropractor questioning whether or not we were really hurt, and asking if the claim was really valid or not. She states she has a letter from a doctor at the hospital stating we were not hurt... I have no idea what she could be talking about there. She has also discussed my oldest son's visits to his psychologist, and in somewhat of a slanderous way I'm told, which is none of anyone else's business-even the chiropractor. I have tried everywhere to find out if auto insurance has to follow HIPAA guidelines, and I can't seem to find the info. In my opinion, even if they don't, she is borderline slanderous in the manner in which she is discussing these issues with the chiropractor and discussing things with him that do not pertain to his field of expertise. He has documented it, and is willing to testify to it if it comes down to that. So, does she have the right to discuss these things with him legally? Is she in violation of some kind of privacy thing, or do I need to just chalk it up to a person full of hot air and blow it off?
Thank you for looking into these 3 things for us!
Answer(1) I think you may be a little bit confused about what is happening. Medpay from your insurer covered your medical expenses in the same way that health insurance would. You now have a bodily injury claim pending against the other insurer. This claim value is subjective and the amount will be negotiated. If you can't agree on a value, then you'll need to file a lawsuit and let a judge orjury decide. The other insurer will not pay the chiro or psychologist bills. There will be no settlement with the chiro. They will settle with you for a subjective total amount that includes medical expenses, pain, suffering, and aggravation.
(2) Therapy bills are unusual for auto accidents, but they can be necessary, if an accident was particularly traumatice, or if a party witnessed something horrible. Since your son had anxiety, it is reasonable that he might have needed some additional care. But I would not expect more than a couple visits, based on what you described. I think a judge/jury would agree.
(3) Everyone is subject to HIPPA laws, including auto insurers. But I'm not sure she violated any laws, so I'd probably let it go. Maybe mention to her you'd appreciate it if she wouldn't do it again.
If you need help estimating the value of the claims, please provide the following:
-itemized list of medical visits and cost
-amount of any lost wages?
-amount of collision damage
-diagnosis and prognosis
