Using Health Insurance for a Car Accident Injury

How your standard health insurance coverage might come into play after a car accident, and what to watch out for.

After a car accident, getting medical care can become a tricky situation if a number of different insurance policies are in place. Injured parties are often unsure which insurance coverage to use to pay medical bills and other health care costs, and it may even be unclear whether their standard health insurance will cover car accident injuries.

Exactly how much ultimate responsibility a particular party or insurance carrier has can depend on a number of factors -- including any deductible or co-pay on the policy (or policies) in play, who was at fault for the car accident, and the types of car insurance coverage in place. Ultimately, most health insurance plans/policies will cover car accident injury bills, at least up to a point, but your health insurer might not ultimately be on the financial hook. In this article, we'll take a closer look at some key issues related to health insurance and car accident injuries.

Co-Pays, Deductibles and Car Accident Injury Bills

In most cases, car accident injury bills will follow a basic pattern of payment responsibility. The first piece of the pie will involve any co-pays or deductibles in place on the insurance policy in question, which is usually a standard health insurance policy (assuming you have health coverage). In the typical situation, you get injured in a car accident, you get medical care for those injuries, and you follow the same protocol that you would if you were getting medical treatment for an illness or any other health issue. That means you will have to pay the usual deductible or co-pay under your health plan.

Hospitals, ambulances and doctor's offices may not require upfront payment from injured parties. Instead, they may provide necessary services and then work with the patient (you) and any involved insurance companies to determine who needs to pay what amount.

So, for example, if you're taken from the accident scene to the ER via ambulance, don't be surprised if a few weeks later you receive a hefty bill from the ambulance company (or your local city/county). This bill (which could amount to thousands of dollars) will typically include a section asking whether you have health insurance. If you do have health coverage, you'll be asked to provide policy/plan details in space provided and mail the bill back (without paying it). The ambulance company (or city/county) will then deal with your health plan to get payment.

Auto Policies Pay First

When it comes to actual insurance company responsibility for a car accident injury, the first payments are supposed to be charged against an auto policy in place. Most states require motorists to have basic liability car insurance coverage. The amount of coverage can vary greatly, but medical bills will or should be paid up to the at-fault driver's policy limits. If your health insurance coverage paid your medical bills first, the health insurer will turn around and make a claim against the car insurance company that insures the at-fault driver.

Cycling into Medical Insurance Coverage

Generally, your health insurance carrier/plan will have final financial responsibility for treatment related to car accident injuries as soon as all other forms of payment are exhausted. What is covered and what is not will hinge on the policy itself. Injured patients will likely still have to pay:

  • their deductible amount under their health insurance policy
  • any co-payments that are required under a health insurance policy, and
  • for any charges that are not typically covered by the policy.

Recovering Expenses

As touched on above, if the injured claimant is not the at-fault driver, the insurance companies involved may work behind the scenes to get the at-fault party's policies to absorb some or all of the costs. Injured drivers and passengers can also sometimes recover some or all of their out-of-pocket expenses (deductibles, co-pays) by making reimbursement of those costs a component of any car accident settlement agreement with the at-fault driver and/or their insurance carrier.

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