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rear_ended and health insurance question

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prokni

Guest
I got rear-ended a month ago. We both have the same insurance in California.
I finally got call from her adjuster to say that they have accepted the liability.
He has set up the direct bill for rental and car repair(My car is already in body shop)
My wife as a passenger went to emergency room after the accident with ambulance and she has seen her DR once. She might need to go to the DR one more time and hopefully that is set.
Other driver adjuster talked to my wife yesterday and offer her 400 for medial bills and pain and suffering.

Two question:
1-how much should I expect from insurance for medical bills and pain and suffering?
2-My health insurance probably pays his portion for my medical bill. How the process works for that? I know that I would get the mail form my health insurance to see if our medical expense is related to accident or not.
What should I do? Who pays for my co-pay? Who pays for health-insurance portion? Does my health insurance go after other driver insurance or I have to do it? How should I handle it?
Please advice

Appreciated
 


HomeGuru

Senior Member
prokni said:
I got rear-ended a month ago. We both have the same insurance in California.
I finally got call from her adjuster to say that they have accepted the liability.
He has set up the direct bill for rental and car repair(My car is already in body shop)
My wife as a passenger went to emergency room after the accident with ambulance and she has seen her DR once. She might need to go to the DR one more time and hopefully that is set.
Other driver adjuster talked to my wife yesterday and offer her 400 for medial bills and pain and suffering.

Two question:
1-how much should I expect from insurance for medical bills and pain and suffering?
2-My health insurance probably pays his portion for my medical bill. How the process works for that? I know that I would get the mail form my health insurance to see if our medical expense is related to accident or not.
What should I do? Who pays for my co-pay? Who pays for health-insurance portion? Does my health insurance go after other driver insurance or I have to do it? How should I handle it?
Please advice

Appreciated

**A: talk to a PI attorney right away.
 
P

prokni

Guest
I have already talked. they are not interested because my wife probably does not need to go to DR for couple months and they can not make enough money out of it.
 

JETX

Senior Member
Q1) "how much should I expect from insurance for medical bills and pain and suffering?"
A1) No one can answer your question since we don't have enough information. For example,
- Does your wife work??
- Is your wife a heart surgeon (big bucks) or a panhandler (no bucks).
- How much were the actual medical bills?
- How long did she have pain?
- Are there any permanent scars?
- Etc. and Etc. Far too many variables to 'diagnose' long distance.

Q2) "My health insurance probably pays his portion for my medical bill. How the process works for that?"
A2) Depends. Who is the 'his' you are referring to?? Since you talk about your wife, I assume you area a 'he'. Who is the 'other'??

Q3) "What should I do?"
A3) About what??

Q4) "Who pays for my co-pay?"
A4) How did YOU get co-pay expenses? Your post says NOTHING about you having injuries!!

Q5) "Who pays for health-insurance portion?"
A5) What portion?? For what??

Q6) "Does my health insurance go after other driver insurance or I have to do it?"
A6) Don't know.. What are you going after??

Q7) "How should I handle it?"
A7) Don't know..... what does 'it' look like??
 
P

prokni

Guest
assume my wife paid $40 as co-pay for emeregny and the total bill is $400. Who poys for taht portion($400). health insurance or other driver insurance?
Hospital got my health insurance info.They will send the bill to my health insurance.
Please don't fill up the forum with "no", "I don't know the naswer" and stuff like that. Please try to be helpfull. if my question s not clear just let me know and I clear it for you and anybopdy that is here to help.
 
J

JoBarry

Guest
Prokni.

In my case, my medical bills were initially submitted to my employer health insurance company. Since my injury was the result of an auto accident they then required me to submit them to the auto insurance company first. Since my case has been dragging, my employer insurance company ended up paying for most of it. Once a settlement is reached they have the option of subrogating against any settlement amount to reimburse them for money they paid out. In your case, since the other party's carrier has acceptied liability, I would forward receipts for your copayments to them and demand that they reimburse you.

This seems like one of those rare cases where the insurance company is actually working with a claimant, so I doubt you would need an attorney.

I am not an authority figure on any of this.......just passing on info I learned from my accident.
 
P

prokni

Guest
Thanks for your response.
the time of settlement , do I have to be wrorry about how much my health insurance paid and try to include that?
 

JETX

Senior Member
prokni said:
Please don't fill up the forum with "no", "I don't know the naswer" and stuff like that. Please try to be helpfull. if my question s not clear just let me know and I clear it for you and anybopdy that is here to help.
The reason I answered as I did was... your questions are vague and without any answer.... kind of like "what color is it?". You couldn't answer either.

We are not here to play "100 questions". If you have a question, ask it. If you don't know how or what to ask, at least give sufficient information so that someone has at least a hope of trying to figure out what you are asking.

Questions like "What do I do about it?" are a waste of your time and ours.

Your questions should be complete and concise. Don't ramble. Don't assume that anyone can read your mind. You may know what you are talking or asking about.... but we don't.
 
P

prokni

Guest
Undrestood.!
then answer this question(Hope it is straight forward enough)
Do I have to be wrorry about how much my health insurance paid and try to include that at the time of the settlement?
 
J

JoBarry

Guest
Prokni -

You may want to visit the "insurance/health" portion of this site for that answer (as to what criteria they use for subrogation). However, if your wife only incurred $400 dollars in medical I doubt it would be worth it for your health insurance carrier to subrogate that amount (I believe they "contract" with outside companies for a fee to subrogate and I doubt $400 is worth the fight for them). J.
 
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ProResearch

Guest
Here's a couple of points to consider:

When my physiatrist recommended myofascial release therapy for my continued neck and upper back sprain/strain (which x-rays confirmed some trouble spots still existed), I asked him if I should go ahead and ADD that expense to my health insurance or just pay it myself -- and then the at-fault driver's insurance company would reimburse either of us. The doctor said (and an attorney I consulted with agreed), you will get a better rate if you go through your health insurance. Then the health insurance will get the money back when you settle your claim with the other driver's insurance company. I also had physical therapy and medications and other stuff. But that is exactly what happened came time to settle with the at-fault driver's insurance company.

My health insurance had sent me a statement of "My Claim Amounts" and their "Pay Out Amounts," which I used in my "settlement demand package." Needless to say my claim amounts are what the doctors and other medical providers *charged.* Their pay-out amounts are what they allow on the charges. My total medical damages (for claims purposes was just over $7K); the amount I had to pay back to the health insurance company was just shy of $3K. My settlement was $14.5K (without an attorney). With an attorney I probably would have gotten a bit more, but this was fine with me as I didn't have to pay attorney's fees and costs. I also am one f-i-n-e amateur negotiator ;-)

Hope this helps some.......
 
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prokni

Guest
Thanks ProResearch
I am not a good negotiator then I might be in trouble a little bit-)
So far I had $800 bill from my insurance regarding the accident related med.
 

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