Medical Payments Coverage.

Why It Is Important to Have Medical Payments Coverage or Med-pay on Your Auto Insurance.

Have you ever wondered why your auto insurance company encourages you to use your health insurance coverage rather than purchasing med-pay on your auto insurance policy? You can bet the reasons have nothing to do with your health or your wallet. Here are some facts you need to know if you are considering saving a few dollars by not purchasing or eliminating the med-pay portion from your auto policy.

1. Self-Preservation: Despite the law in California, many people drive without auto insurance. In some areas, this figure has been estimated to approach 50%. Thus you cannot reasonably expect the guilty party will be able to pay your medical expenses in the even of an accident that is not your fault. Auto Med-pay will protect you in these situations.

2. Protect Your Passengers: Even though you, the owner of the motor vehicle, may have other health insurance coverage, your passengers may not. Having auto med-pay protects them as well. They can get immediate treatment for any injuries sustained from an auto accident in your car without out-of-pocket expenses.

3. No Unreasonable Restrictions on Med-pay Coverage: Unlike many healthcare plans, especially in managed care, med-pay usually does not have unreasonable restrictions on what is and what is not covered. If you need chiropractic care and more than one or two modalities/procedures, it is usually covered. If you need supplies, there is usually no unreasonable dollar cap. If you need to go to the ER or the hospital, you usually do not have to worry about authorization. If you want to see a specialist of your choice, you can usually do it.

4. Conserves Your Limited Health Insurance Benefits: It is best to save your limited health insurance resources for other times, Often after patients settle their auto claim there is still a need for continuing chiropractic care. In the event of an auto accident, if you use med-pay for your chiropractic care, you will still have your limited health insurance benefits for subsequent care.

5. Minimizes Interference with Your PI Case: The more difficulty you have in obtaining all the medical care you need, the more likely it is that you will receive less care than you need. Such a scenario typically results in a lower settlement for your PI case, since your total medical bills are one of the prime determinants of your final compensation for your injuries.

6. Med-pay is an Excellent Value: Med-pay is relatively inexpensive. For example, for about $50-100/year, you can have $5000 coverage for yourself and every passenger in the car. If you are driving with four passengers that amounts to $25,000 in available coverage. That is the best auto insurance deal around. Having auto med-pay is a smart investment.

7. How much coverage should you carry? Personally, my amount ($25,000) was based on the fact that I was picking up my grand kids & their friends after school or from the day care center. My thinking was "What if an uninsured motorist struck my car & these kids were injured?" Med-Pay gave me the peace of mind that I, or their parents, could take them to whoever we wanted & not have to worry about payment.

If you are injured seriously enough to need an ambulance, did you know it costs between $1000-2000. And... usually your health insurance doesn't cover this. As a matter of fact, your health insurance has a right to be reimbursed for all treatment rendered as a result of a motor vehicle accident.

Why You Should Use Your Med-pay In Auto Accident Cases

1. You have been involved in an auto accident. Many people believe that if they use their med-pay in an auto accident case that wasn't their fault, their auto rates can be increased. NOT TRUE. California Insurance Code 491 prohibit the auto insurance company from doing this. 

2. The auto accident probably wasn't your fault. Many people have strong convictions against using their own men-pay to cover the effects of someone else's mistake. While this argument works somewhat on an emotional level, rationally it makes little sense. Would you still choose not to use your med-pay if the responsible party had no insurance and was unable to pay out of his/her pocket? Of course not. It is your own insurance company's responsibility to seek reimbursement for your medical expenses from the responsible party. So don't worry about that. Your primary job after an auto accident is to get well as fast and as completely as possible. You paid regular premiums for the right to have med-pay, so why not use it when the need arises. As you will see be reading the following there are many advantages to using your med-pay.

3. You have your own auto insurance that covers medical insurance (med-pay). If you don't use your med-pay, have no personal health insurance, and are not willing or able to pay case, the office where you seek treatment will most likely require that you sign a lien. A lien is a legal document that guarantees you will pay, even if the third-party payor refuses to cover your treatment, which may include penalties and interest for failure to pay by a certain time. If the medical establishment does not honor liens, it may not allow you to get treatment or diagnostic procedures at its facility.

4. Your doctor of chiropractic has requested your own auto insurance information for billing purposes. When using your med-pay, your treating doctor doesn't have to wait until the resolution of your case to get paid. When one depends solely upon the third-party payor (the auto insurance company of the person who caused the accident), medical bills can take many months to be paid. While many doctors endure this wait as a courtesy to their patients, this delay is unnecessary if you have med-pay.

5. You are hesitant about using this med-pay portion of your auto policy. When you use your med-pay coverage, you have the protection of the "bad faith" laws in California. This protection helps assure that you will be treated fairly by the auto insurance company. A bad faith violation could cost your auto insurance plenty, so you have considerable leverage on your side. Third-party payors are exempt from bad faith laws in California, so this same protection does not exist, making you vulnerable to abuse.

OUR OFFICE STRONGLY RECOMMENDS THAT YOU USE YOUR MED-PAY POLICY TO COVER TREATMENT FOR YOUR AUTO ACCIDENT INJURIES.

FINALLY, in the best-case scenario, you should have non-reimbursable med-pay.

1. How much non-reimbursable med-pay should you buy? In California the minimum limit for liability is $15,000; which is what the law requires each of us to have for the protection of a stranger we may negligently injure. Surely we would not want less protection for ourselves, a family member or a passenger.

2. How do you buy non-reimbursable med-pay? You have to ask for med-pay by name, ask for it to be non-reimbursable from a personal injury recovery, and ask for limits of more that $15,000. If your agent or insurance company does not provide this type of coverage, do not hesitate to go elsewhere. Be prepared for agents who are less that fully informative, forthright, and cooperative. Many will not offer med-pay coverage unless you ask for it and, when you do, may try to convince you that you do not need it, because you already have health insurance through work.

Dr. Lyon's NOTE: Most insurances do not want to sell you this coverage. Even when I applied online to a major insurance carrier & selected the Med Pay coverage I wanted, when the program finalized my selection it deleted Med Pay & I had to manually re-insert it.

There's also something called Excess Med Pay. This is when your private health insurance is the primary payer and only after they will no longer pay or they deny payment, then your Med Pay starts paying or pays the excess.
1) For example, if I was not a provider on your HMO or PPO insurance plan, I would have to bill your Primary health insurance for a denial that I would need to send to your auto insurance company to be allowed to be reimbursed out of Med-Pay.
2) If I was a provider, I would be paid directly from your health insurance, and any excess expenses would be covered by your med-pay by separately billing your auto insurance.