Finally released what now?

[g8tor123]

What is the name of your state? Virginia

I was rear-ended about 1 year ago and after nearly a year of medical care I've finally been released. I retained a Personal Injury attorney shortly after the accident because the other guy’s insurance company would not leave me alone. I've read about the settlement process on the web but have some basic questions. My billed medical to my HMO is about $18,000 but the discount ended up being around $7,000. I am pretty sure subrogation applies based on what my attorney told me some time ago. My questions are:

1) What value is used to determine the medical costs/settlement...the HMO or the amount billed by the doctors?

2) How common is it for an attorney to argue against subrogation or negotiate for 1/3 off for collecting the amount. This is what my attorney indicated they would try to do.

3) Most importantly I hope that by retaining an lawyer that all parties (e.g. my HMO) will get what they are supposed to get and all such "loose ends" will be resolved. I certainly do not want to get a bill from someone down the road saying that they are entitled to part of the settlement if there is one. Will the lawyer make sure everything is resolved so I can get this behind me?’

Thank You for your help.

[moburkes]

Originally Posted by g8tor123

What is the name of your state? Virginia

I was rear-ended about 1 year ago and after nearly a year of medical care I've finally been released. I retained a Personal Injury attorney shortly after the accident because the other guy’s insurance company would not leave me alone. I've read about the settlement process on the web but have some basic questions. My billed medical to my HMO is about $18,000 but the discount ended up being around $7,000. I am pretty sure subrogation applies based on what my attorney told me some time ago. My questions are:

1) What value is used to determine the medical costs/settlement...the HMO or the amount billed by the doctors? Medical COSTS are medical COSTS. If it didn't cost $18k, then it didn't cost $18k.

2) How common is it for an attorney to argue against subrogation or negotiate for 1/3 off for collecting the amount. This is what my attorney indicated they would try to do.Ask your attorney how often he's asked for this - and won.

3) Most importantly I hope that by retaining an lawyer that all parties (e.g. my HMO) will get what they are supposed to get and all such "loose ends" will be resolved. I certainly do not want to get a bill from someone down the road saying that they are entitled to part of the settlement if there is one. Will the lawyer make sure everything is resolved so I can get this behind me?’ Is he a good attorney?

Thank You for your help.

We don't know what you will get as a settlement.

[ecmst12]

You will only have to pay your insurance company back for the money they actually spent. Whatever they negotiated off the doctor's original fee will not be your responsibility, you only have to make the HMO "whole" regarding actual cost to them.

The full cost of the bills will be taken into account when determining the settlement, but not via any strict formula, it's just used as one way of measuring how much treatment you required.

Just make sure that whatever you get, there will be enough to pay back the insurance company and have whatever amount you are looking for left over. Remember your lawyer gets paid first and you have to pay the health insurance and everyone else out of the remaining 2/3.

[stephenk]

Since your HMO decided to accept $7k as the full amount of their billing, that is the amount the other carrier will consider in making any settlement offer. The reason is that you can't demand a settlement based upon $18k in medical bills is because you would be receiving a recovery above the actual accepted billing amount. You can't make a profit off of the billing if the HMO agrees their $18k in charges is really only worth $7k.