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Settlement: "paid" vs. "billed" medical bill amounts

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capndavy

Junior Member
What is the name of your state?OHIO

The tortfeasor's insurance company has offered me a settlement of 5 Times my medical bills for injuries I sustained in a car/motorscooter accident caused by their insured.
The twist is the adjuster has used the discounted amounts negotiated between United Health Care and the individual doctors and hospitals, not the actual bills for treatment. The Subrogation service has sent the insurance company a statement showing both "amount billed" and "amount paid" totals. Paid amounts, the lower negotiated amounts, have been chosen to calculate my settlement.

I contend that the Amount Billed properly reflects the injury. The paid amount is a product of UHC's negotiation skill and the doctors' desire for referrals from UHC's customer base and in no way reflects the extent of my injuries.

(ruptured ligament in thumb requiring surgery, resultant limited movement of thumb joint, crushed outer thumb joint, onset of arthritis in that joint and permanent painful joint movement)

$8994 is what the UHC is seeking for repayment of medical bills. $14,335 was the price of treatment before the UHC "discount".

What do I do in this case? Is the insurance company's manuver proper?
 


emartin890

Junior Member
Hello,
I am also trying to settle my own claim, so far so good, I have gone to an attorney for advise and he told me I had done such a good job I ought to try one final offer to settle, if I cannot get them where I want it, he will take over and only take fees for what he gets above what I have negotiated.

As far as the bills.. from my reasearch during this process. The insurance company and the insured have NO RIGHT to benefit from your insight in having insurance.. Had you not had it they would be facing the ACTUAL bills not the reduced amount negotiated by your HMO.. It falls under what they call the collateral source rule.. Go back to them tell them you want 5 times actual bills and mention the collateral source rule.. My advice would be to get an attorney opinion, but as long as you have asked for a high amount no harm done trying to get what you can before the attorney takes it the rest of the way..
Good luck!!! Hope this helps some..
 

teflon_jones

Senior Member
It doesn't matter whether they use the billed or paid medical bills. You only need to look at the end number. If the amount doesn't make you happy, ask for more. There is no formula to calculate what it should be. The 5X the bills is just what they used. It doesn't mean you can't use 7X the bills.
 

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