Does Health Insurance Cover Car Accident Injuries?
Dealing with injuries and medical bills after a car accident can be extremely stressful. You may be wondering if your health insurance will cover the costs of treatment and rehabilitation. Unfortunately, there is no simple answer. The amount your health insurer pays depends on several key factors.
These include what type of health plan you have, who caused the collision, the types of injuries sustained, and whether you carry medical payments coverage through auto insurance. Given the complexity, many accident victims are left confused about what exactly their health insurance does and does not cover.
To help make sense of this issue, we will analyze how health coverage works for car crash injuries. By understanding the nuances, you can ensure proper claims are filed and avoid massive out-of-pocket expenses. Let’s take a close look at how your health insurer may handle medical bills and lost wages resulting from an auto accident.
Health Insurance Basics
Before answering the question ‘does health insurance cover car accident injuries?’, it helps to understand the basics of health insurance in general. There are two main types of health insurance plans:
- Employer-sponsored plans: These are group health plans offered by employers to their workers. They often have lower premiums and deductibles.
- Individual plans: As the name suggests, these are plans you purchase directly from an insurance provider. Premiums and out-of-pocket costs tend to be higher.
Both types of plans can be further divided into:
- HMOs (Health Maintenance Organizations) - Requires you to use in-network providers.
- PPOs (Preferred Provider Organizations) - Allows you to see out-of-network providers, but you pay more.
- POS (Point of Service) - Combines features of HMO and PPO plans.
No matter the type, health plans will only cover injuries caused by a car accident up to the limits of your policy. Once those limits are reached, you become responsible for any remaining costs.
Who Was at Fault?
One of the biggest factors in whether health insurance covers accident injuries is who the at-fault party was.
If the other driver caused the collision through their negligence - like speeding or running a red light - their liability insurance should pay for your medical treatment.
However, if you were at fault or it was determined no one was to blame, your health insurer would become your primary payer.
This is an important distinction because most health plans require you to pay a deductible and copays for medical services. If the at-fault driver’s insurance is paying, those out-of-pocket expenses disappear.
So, be sure to contact an experienced car accident lawyer Lancaster CA to investigate fault and make sure the liable party accepts responsibility.
Type of Injuries
The types of injuries you sustained will also impact how your health plan handles coverage. Plans are required to cover essential health benefits under the Affordable Care Act. This includes emergency services, hospital stays, prescription drugs, and more.
So, any immediate medical care you need after an accident - like an ambulance ride, ER visit, or hospital admission - would likely be covered up to your plan limits. The same goes for medications, physical therapy, mental health services, and follow-up visits that are considered essential.
However, optional or cosmetic treatments may not be covered. For example, scar revision surgery or Botox injections to reduce scarring would likely be considered elective. You'd have to pay those expenses out-of-pocket.
Again, getting the at-fault driver's insurer to cover everything related to your injuries is ideal. But at minimum, your health insurer will pay for essential medical services per your policy.
Medical Payments Coverage
One way to fill coverage gaps left by your health plan is to have medical payments (MedPay) coverage through your auto insurance.
This optional coverage pays for injuries to you and your passengers from a car accident, regardless of who was at fault. It provides an additional layer of protection beyond what health insurance covers.
MedPay coverage is relatively affordable and has limits typically between $1,000-$10,000. It can be used to pay health plan deductibles, copays, medical equipment costs, and other expenses related to accident injuries.
If you don’t currently carry MedPay but have health insurance, it’s worth looking into adding this extra protection.
Steps to Take After an Accident
If you’ve been in a car crash and need medical treatment, here are some important steps to take regarding insurance coverage:
- Seek immediate medical help if needed - Get checked out at the ER or urgent care for any serious injuries. These emergency services will likely be covered.
- Report the accident to your health insurer - Notify them right away so they have documentation of your injuries should claims need to be filed.
- Contact the at-fault driver’s insurance - Have their insurer accept liability so that the company pays for your medical expenses instead of billing your health plan. It’s best to get an attorney to do this on your behalf.
- Review your health policy - Understand your deductibles, copays, coverage limits, and excluded services so there are no surprises.
- Consider hiring an attorney - They can deal with the insurance companies and make sure you receive the maximum compensation possible. An experienced Lancaster car accident lawyer may even be able to get your medical bills covered at no cost to you.
- Use MedPay if available - If you carry this coverage, take advantage of it to fill any gaps left by your health insurance.
Dealing with injuries, car repairs, lost income, and insurance claims after an accident can quickly become overwhelming. But understanding what your health insurance does and does not cover is a crucial first step.
Contact Karns & Karns Personal Injury and Accident Attorneys for Assistance
With health insurance and car insurance policies designed to be confusing, it can be hard to know what to do for the best. However, an experienced personal injury law firm can help protect your rights and get you the maximum compensation you deserve. Karns & Karns Personal Injury and Accident Attorneys has recovered millions of dollars in settlements for our clients. If you or a loved one has been injured in a crash, contact us today for a free consultation by calling 800-4THE-WIN (800-484-3946).
