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Managed Care and Personal Injury Litigation – Best Practice

Managed Care

If your family’s health insurance is through a health maintenance organization (HMO), consider the problems of managed care. It can be difficult to get a referral to a specialist since there may be financial disincentives for your primary care doctor to make such referrals. If you are injured in a motor vehicle accident, you may be able to avoid this problem. Assuming that you have coverage for accident-related medical bills in your auto insurance policy, it is likely that your auto insurance coverage is primary to your health insurance coverage.

If your auto insurance is primary, you submit your bills first to the auto insurer and only any unpaid balance to the secondary health insurer. If your auto coverage is primary, you can select any doctor you wish and see any specialists that are necessary. Your auto insurance company will have to pay all reasonable and necessary bills for treatment related to your injuries. Only when your auto benefits are exhausted would you have to be concerned with your health insurance company’s guidelines regarding the medical providers you can see. You should check with your lawyer about this since, again, the law varies from state to state. The last thing you want is to be stuck with unpaid medical bills after you have settled your case.

If your auto insurance is not primary, you will need to carefully follow the guidelines of your health insurance company. If you fail to do so, it is very possible that all insurance companies involved in your accident will deny payments based on your failure to follow these guidelines.

If you were injured in a slip and fall accident, you will need to carefully follow the health insurance company’s guidelines. In some states, if you fail to do so, the insurance company responsible for covering this accident will not have to pay your medical bills. Be sure to go to your primary care physician initially and then get any required pre-approval before you see any specialists. This is, again, an area where the law varies from state to state. You should think out this issue carefully before you choose your treating physicians.

If you need more information or think you need an attorney, please contact Evan Aidman, Esq..

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