Posted 1/26/2011 7:03 PM (GMT 0)
I had an accident where the other party was drunk, and hit me head on in my lane of traffic, after dark with no lights on. It was his fault, but , unfortunately, he only had 100 000 as it was an SR22, or something like that due to all his prior offenses. I had health insurance, car insurance, and my husband's health insurance. I was taken by ambulance to the hospital. Depending on your state's law, you can sometimes be entitled to both, but in others, like mine, the car insurance is primarily responsible. So, the hospital, drs, can choose to accept the payment from the accident, but most know it may be years before they get paid, due to possible litigation, settlements, etc. Initially, my health insurance paid, as didi my husbands', and with over a $100000 overpayment from them, the hospital still filed a claim against the insurance payment from the other driver. This was just the initial expenses, as due to the injuries it has actually been ongoing for years, but his money was long ago exhausted. I had what is called a third party provider as health insurance, which basically means that it was not an actual health insurance plan, but a plan where they rent the providers, etc. In out state, the judge(if Iwent to court) could rule that is was health insurance and had to act like any health insurance, because that is how they list it as benefits. But as a third party provider, they did not want to pay if another party was responsible. IN the end, with no attorney, my health insurance paid and I did get his $100 000, as I got the hospital to release the lien agaisnt the remaining. $30000. The first check I got right after the accident was my car value. Then a few months in, the balance that did not have the lien against it. Then year or more the balance that was the lien. The auto ins. just wanted to settle, as they knew from the injuries and the bills submitted, from the ER, and the first surgery, that the claim would exceed his 100000plan. The hospital was the hold up. I do no believe that the car insurance can stop you from having any treatement of any kind, as they do not have that authority, they only have the reponsibility for the accident, and payment of the bills submitted to them. ( am an RN, who was also the Credit manager for a Clinic, for years.) So I am not sure who is denying your claim. IF prior authorization is not required for your health insurance, then I do not understand why any procedures are being denied. You go to a dr or hospital.who takes your insurance, and seek treatment. After the bills are submitted, the health ins co should send you a letter, asking is there should be any other person, or policy responsibile for the bills. Then you list the other person's insurance, and if you have under or uninsured drivers coverage, yours as a secondary. Yours would then pay onlly if the other persons policy was exceeded. You will not receive any personal payment if the bills exceed the coverage. Then , if the bills exceed the accident coverage, your health insurance will have to come in and pay the bills. You can call the insurance commission of your state for advice. The biggest problem with an attorney, is that they take 30 or 40% of what you receive., as settlement for pain and suffering. IF there is true fault of the accident the company usually cooperates, by just contact from your insurance company and there is no use for the attorney. Perhaps, the biggest problem you have is that you have waited a year. The injuries should have been evident from the day of the accident, and treatment followed. I guess I did not get all the details from your post as to why you were not initially treated for all the injuries you received at the time. That may be the problem with the insurance company not settling, as it is usually done in 90 days, or at least before the end of the year, so as to avoid carrying it forward. More info would help. T