Copies of bills following accident

[JennyP410]

What is the name of your state? Georgia

This isn't exactly an accident question...more of a settlement question.

I'm currently dealing with an adjustor for an accident several months ago. I thought I had submitted everything, but the claims dept sent it back to her for copies of the bills.

I sent both the "explaination of benefits" from my insurance co, which shows the amount billed and which doctor, and a report from each doctor visit that shows the dollar amount for that visit.

She says they need actual copies of the bills. That doesn't seem that hard, but I can't get the big medical conglomerate to send me JUST a bill. I've paid them all along, so what they send me is what she said doesn't suffice.

I also don't want the adjustor to see what my health insurance DID pay, because I feel like she will deduct that from a settlement. They have already told me that they made mistakes and should not have paid some of these bills, and I've been contacted by their subrogation dept, so I will probably be paying them back.

Is this customary? I thought what I had sent was more than enough because it includes what each charge is actually for.

 

[fcobarr]

Your demand letter should have 3 parts:

What was paid out for medical bills
What was lost in wages
pain and suffering

Each component has it's own value, so I'm not sure what you are worried about. They can't pay you more for the medical portion of the settlement than has been paid out. So, just make sure you are properly compensated for the pain and suffering. The other two categories are very straight forward calculations.

Also, keep in mind, any monies paid out by your health insurance (or auto insurance) will be taken out of your settlement as reimbursement for medical bills which they paid.

Good luck.

 

[JennyP410]

My demand letter did include those three parts, each clearly delineated and backed up with the appropriate documentation.

I guess I am concerned about the dollar amount of the medical bills because there is a total amount and then there is the much lower actual amount due. My health insurance didn't pay 90% of the bills, but I only have to pay the negotiated rate that insurance would have owed. Therefor, the amount actually paid is about 60% of the total. (If that makes sense)

I don't want her to base pain and suffering monies on the lower dollar amount. I think they should be based on the full total. So I guess that is what I am concerned about. I don't want her to realize the difference. The injuries were very serious, but much like a broken rib, they just had to heal on their own. So med bills are low compared to the extent of injuries.

 

[ecmst12]

You should be able to get copies of the actual bills with the original amounts on them from the providers. Pain and suffering is not directly based on amount of medical bills anyway so whether they see the negotiated rate or not doesn't much matter. What matters is the fact that you were bedridden for an extended period of time, unable to work or engage in most of your normal activities, and experienced a significant amount of pain during your recovery, to say noting of the inconvenience!

 

[fcobarr]

While pain and suffering is tied to medical bills to a certain degree...you can put whatever dollar amount you want for pain and suffering.

Have the medical bills been paid already or are the providers waiting for settlement? If not, they probably have a lien against your settlement for the negotiated amount. If they are asking what the medical bills are, if you don't tell them what was paid...I would consider that fraud. In the end, I think they would find out.

Why would medical bills be low compared to the injuries? I don't understand. What were your injuries? What injuries are permanent? Any scarring? Did you get a evaluation/report from an expert witness regarding your injuries and any future medical care that may be required as a result? Are you still under doctor's care? Give a little more information about what sort of $$ you're talking about.

I was in an accident in Nov 07...my wife suffered serious injuries from laceration on scalp, fractured neck, fractured lumbar vertebrae, pelvic ring broken in multiple places, fractured radius and ulna, severe injuries in rt foot. 5 surgeries later she is still in therapy and may need additional ones in the future. I am presently dealing with many people to sort everything out from medical bills to settlement. I've learned a lot about the "system".

 

[JennyP410]

Wow - I certainly wish your wife a speedy recovery.

My accident was July 1st of 2007. You can search for my other thread, but to be brief, we were on a motorcycle, someone caused the accident who was charged with DUI, making terroristic threats, reckless driving, etc.

I had a broken pelvis that did not require surgery. It was a complete break that also involved the acetabulum, but thankfully it was aligned. Missed nearly eight weeks of work, spent most of that time immobile to prevent the break from shifting. There was some road rash that caused scarring, and various other injuries. The pelvic break was the worst, and will potentially cause the most complications in the future. My doctor's reports seemed to be thorough and detailed what to expect in the future.

I am making payments on the medical bills. Some have been paid in full, I still owe on others. Total $$ is roughly 10K.

Doctor released me two months ago. Adjustor has had info since then, but is dragging her feet.