Should I use my own health insurance after an auto accident that was not my fault?

The answer to this question is “yes”; you can use your health insurance and you should use your health insurance.

I often have clients that ask me this question, thinking the other at fault driver should pay their medical bills up front or the client thinks that they should use their automobile insurance instead of their health insurance.  Even some medical providers have mistakenly advised my clients that they cannot use their health insurance after a car accident. 

There is nothing in your health insurance policy that prohibits you from using your health insurance after an auto accident. In fact, most policies allow for it and simply provide that if you receive a settlement, the health insurance company must be paid back from your eventual settlement the amount the health insurer paid for your medical bills.  That said, under most health insurance policies in California, your health insurer will not be paid back the full amount it paid for your medical bills; this re-payment amount will me negotiated down by your attorney once your auto accident case resolves.

Auto accident cases can take time to resolve if you want to resolve your case for a fair and just amount.  The most important thing after an auto accident is that you receive appropriate medical treatment immediately.  Use your health insurance for this.  If you have out-of-pocket expenses, like co-payments or co-insurance payments, your attorney can get you reimbursed for those expenses immediately if you have “medical payments” coverage under your auto policy.  If you do not have “medical payments” coverage under your auto policy, you will need to keep track of these out-of-pocket expenses so that your lawyer can recover them for you from the other driver who was at fault for the accident once a settlement is reached.

As stated above, some medical providers will incorrectly advise you that, if you have “medical payments” coverage under your auto policy, you must first exhaust this coverage before using your health insurance.  This is not correct; you can and should begin using your health insurance immediately.  Your “medical payments” coverage under your auto policy, if you have it, will be for a limited and defined dollar amount.  There is no reason to exhaust this available money quickly on care that could have otherwise been paid for my your health insurance.  Instead, use your “medical payments” coverage for out-of-pocket expenses not covered by your health insurance.  Using your “medical payments” coverage under your auto policy in this way allows you to have all of your medical care covered for a longer period of time while your attorney seeks to maximize your settlement from the responsible party.

For the other party to ultimately pay for your health care expenses, your lawyer must prove that your medical care and the bills you incurred for your medical care are both “reasonable” and “necessary.” The easiest way to accomplish this is for the client to immediately see their primary care physician and then obtain the appropriate medical referrals from there.  The defense is hard-pressed to argue that your medical care was not “reasonable and necessary” when your own physician has determined that it is necessary and your health insurer has done the same thing by agreeing to pay for it.  Additionally, health insurers typically have pre-existing contracts with doctors and hospitals whereby they reimburse your medical providers at less than the billed rate, further strengthening your argument that the medical bills that were ultimately paid by your health insurer are “reasonable.” If you begin paying cash for medical treatment or seeing medical providers on a lien basis, their bills can often be inflated and the client can then find themselves in the unnecessary position where they now owe medical bills that cannot be recovered from the responsible party at the full billed amount.

The above being said, if you do not have health insurance, you will likely be required to treat with doctors on a lien basis.  There are many great doctors who treat on a lien basis, provide excellent care to their patients, and bill at a reasonable rate.  Any injury lawyer you consult with should have access to these types of physicians.  If you do not have health insurance, you should advise your lawyer immediately so that your lawyer can get you to the correct physicians and you can begin appropriate medical treatment as soon as possible.

Lastly, if you are treating through your health insurance and the doctor or health insurance company you are using will not refer you to the type of specialist you think you need to see or will not approve a diagnostic test you believe is necessary to find out the cause of your symptoms, immediately advise your lawyer. Your medical care can proceed on a hybrid basis where most of your care is being provided through your health insurer, but your lawyer can get you seen by a specialist your health insurer is not willing to approve or to a facility to obtain diagnostic tests that your health insurer may not be willing to cover.