Health Insurance – Your Last Resort

Personal injury protection (PIP) is the first place to go to get your medical bills paid if you have been in a car crash.  If you’ve been in a crash, call your own insurance company and speak to an adjuster about using your PIP for medical treatments.

PIP only pays $15,000 toward your medical bills, unless you have paid for higher coverage. Once that $15,000 is gone, your health insurance will have to start paying.  And PIP only pays for one year, so if you need treatment for more than one year, you will need to be under your health insurance, even if you have not yet surpassed the $15,000.  There are additional circumstances where PIP may not pay, and in such cases, you will need to rely on your health insurance.

If you have to use your health insurance to pay medial bills from a car crash, you may be in for a shock.  Almost every health insurance policy in Oregon has a clause in it that you are probably unaware of.  The clause is usually written in mind-numbing legalese, but the meaning is something like this: “If you are hurt in an accident, and the accident it someone else’s fault, and you get money for that accident from the person who hit you, then you will have to pay us back for all the medical care that we paid for because of that accident.”

With all the premiums you have been paying for your health insurance, you would think they would have to pay for your medical care when you have been injured.  As it turns out, that payment is often just a loan, because your health insurer will put a lien on your case.

This is a shameful situation that should be corrected.  Nonetheless, it is Oregon law.  Almost all health insurance policies have this clause written in the contract that you signed when you bought your health insurance policy.  You need to be aware that if you are in an accident and your health insurance pays $20,000 toward your medical care for your accident, and then later you get $50,000 from the insurance company of the person who hit you, your insurance company is going to want its $20,000 back.

A good lawyer can often negotiate with your health insurance company and get them to reduce that amount, so that they collect less than the full amount they paid.  But you are going to have to pay them back something, and if you do not negotiate hard, you are going to have to pay them back every penny.