How is that fair? The medical provider you have treated with all your life may have this policy and you may not even know it until it is too late. Ask your doctor’s office, “If I am ever in a car wreck, would you treat me?” You may be surprised by the answer. The time to find out the answer to this question is now. Imagine trying to find a new medical provider along with everything else that is on your plate after a wreck, including trying to get your car repaired or finding a new car. You may even see a sign in the waiting room that says “We do not treat people injured in car wrecks.” This is not a good sign, literally, and you should seriously consider what this would mean for you if you are ever in a car wreck.
Why would a medical provider refuse to treat an injury victim but treat the person who caused the wreck? I cannot speak for them, but I suspect fear of having to deal with and frustration over dealing with health insurance companies who refuse to pay bills for car accident victims is how it began. Over the past eleven years, out of the hundreds of people we have helped, in only a few cases have we seen an outright refusal by a health insurer to pay a medical provider due to the existence of a potential claim against the person at fault. Further, in those few cases, the health insurer provided a second document that they wanted to be signed before they would pay for the medical care.
Even though you have paid health insurance premiums your whole life, some health insurers feel that the person who caused the wreck, not them, should ultimately be responsible for the bill. However, it sometimes takes many months to get the car insurance company for the at fault person to pay your claim and you may need critical medical care right away. Thus, what typically happens is health insurance pays for your treatment and seeks reimbursement (if they have a right to do so) at the end of the case. This will likely be under the “third party claims” and/or “reimbursement” section of the health insurance plan. But, no such “third party claim” exists for the person who is completely at fault for the wreck. So, some, but not all, health insurance companies pay for the person who caused the wreck while they may claim to have the option not to pay for treatment for the person who was not at fault, the innocent victim of the wreck. NOT ALL HEALTH INSURANCE POLICIES HAVE AND/OR ENFORCE this clause or take the position of outright denying to pay for treatment. Again, over the past 11 years we have found that even where the health insurance company has this clause in the policy, in nearly all of the cases we have handled the health insurance company exercises their option to pay for medical care where the person has been injured in a car wreck and seek reimbursement from the injury settlement. Thus, the injury victim gets the treatment, the physician gets paid their usual negotiated amount by health insurance, and we deal with the health insurer reimbursement claim at the end of the case, at which point the health insurer may negotiate down the bill or it may turn out they have no enforceable reimbursement claim at all.
Thus, due to the bad (and in my opinion unfair) acts of some health insurers, some medical providers have become frustrated and find it easier to just deny treatment to all accident victims. The effect is they will, for example, provide physical therapy to the drunk driver who ran the stop sign and hurt his back, but they will not provide therapy to their innocent patient who the drunk driver injured. If your medical provider has this policy, please know that there are many medical providers out there who do treat injury victims each and every day. Thus, if you have the option to move your care to one of those physicians, it may be worth considering.