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Use of Health Insurance, Medicaid, or Medicare

If you are involved in any type of motor vehicle accident, you need to initially file any loss claims through your own auto insurance provider. But what if you are injured because of someone else’s carelessness or negligence, but it’s not in a motor vehicle accident. If you have Medicaid, Medicare or private or employer-sponsored health insurance, you should promptly go to your doctor or the hospital, if necessary, to get the treatment you need, and file a claim for any medical expenses through your health insurance provider.

It’s important to understand, though, that if you file a lawsuit for injuries received, if you recover financial compensation for medical expenses, any insurance benefits you received prior to the judgment or settlement in the lawsuit will have to be repaid, under a legal concept known as “subrogation.” Essentially, the insurance company has advanced you the money to pay for medical care, and is entitled to reimbursement, if you recover any amount in a lawsuit.

The rights of Medicare and Medicaid to recover funds paid to you are set forth in federal and state law. Both Medicare and Medicaid will almost always accept 1/3 less of what is owed, because your attorney is generally taking 1/3 of your recovery from the person, or business that caused your injury.

With private or employer-sponsored health insurance, there is typically a subrogation clause in your policy, entitling the insurance company to some level of reimbursement if you recover money pursuant to legal action. Some insurance companies will accept 1/3 less, and others will ask for full reimbursement of any amounts paid. It is up to your attorney to try to negotiate it as best as possible to get them paid.

From my perspective, the most important thing you need to do after an accident is get healthy. Money is going to come and go, but your health is something that you want to maintain as best as possible throughout your life. You do not go to the doctor to make money. You go to the doctor or doctors to get healthy.

You never want to stop going to a doctor because of fears about money, and end up with a problem that could have been resolved by going to the doctor, therapy, or whatever else the doctor prescribed for you to do.

Contact Our Office

To arrange a free initial consultation, contact us online or call our office at (302) 777-1000. Evening and weekend meetings can be arranged upon request. We will come to your home or the hospital, if necessary.

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