Who Pays Your Medical Bills After a Montgomery County Car Accident? Understanding Pennsylvania Med Pay

After a car accident, medical bills may arrive before fault is determined. Emergency room trips, ambulance rides, scans, follow-up visits, and physical therapy can really add up, and many drivers who get hurt naturally expect the other driver’s insurance to take care of those bills. In Pennsylvania, however, the first source of payment for your medical bills is usually your own auto insurance policy.

Anthony C. Gagliano, III, Esquire, P.C. can help Montgomery County car accident victims understand their coverage.

How Pennsylvania’s No-Fault System Handles Medical Bills

Pennsylvania uses a no-fault system for medical expenses. This means that after an accident, your own insurance company generally pays your medical bills up to your policy limits, regardless of who was at fault. This is called “med pay,” personal injury protection, or, more commonly, first-party or medical benefits.

Under 75 Pa.C.S. § 1711, auto insurance policies issued in Pennsylvania must include at least $5,000 in first-party medical benefits. Insurers must also offer higher limits, at least $100,000 in medical benefits, and many drivers can purchase optional coverage for lost income, funeral expenses, accidental death, and extraordinary medical expenses. Your declarations page will show the amount of medical benefits coverage you selected.

Which Policy Pays First?

Pennsylvania law also sets out the order in which insurance policies pay first-party benefits. In Pennsylvania, if you are the named insured on an auto policy, then that policy will generally pay first. If you do not have your own policy, you may be covered under the policy of a relative who lives in your household.

If neither of those applies, the policy covering the vehicle you were occupying at the time of the accident will generally provide benefits. Pedestrians and others who have no auto insurance available to them may be able to recover from the policy covering a vehicle involved in the accident, and if no coverage is available at all, Pennsylvania’s Assigned Claims Plan may provide limited benefits.

There are important exceptions to these rules. An owner of a registered vehicle who fails to carry the required insurance is generally ineligible for first-party benefits. If you were injured on the way to work, then Workers’ Compensation may apply. What Happens When Your Medical Benefits Run Out?

If you’re carrying just the minimum $5,000 in coverage, your medical benefits might run out fast, sometimes in just the first few weeks of care. Once your first-party benefits are used up, your health insurance typically becomes the next source of payment. Generally, your health insurance will expect your auto insurance to pay out first until your auto coverage is exhausted. This is why many policies exceed the minimum coverage amount, as the additional protection is considered to be well worth the increased cost.

Medical expenses that exceed your first-party benefits can often be included in a claim against the at-fault driver. Generally, you cannot recover any amounts already payable or paid by your first-party benefits from the at-fault party. In addition, health insurance plans may seek to be reimbursed from any reward you receive.

Medical Providers And The Auto Fee Schedule

When a medical provider bills your auto insurance for accident-related treatment, Pennsylvania law generally limits the amount the provider may charge. Under Pennsylvania law, providers are subject to a fee schedule and generally may not bill you for the difference between their usual charges and the amount the auto insurer is required to pay. This protection depends on the bill being submitted to your auto insurer, so it is important that providers know your treatment is related to a car accident.

Auto insurers can also challenge whether treatment is reasonable and necessary by sending your medical records for peer review.

To protect yourself, make sure every provider has your auto insurance claim information so that bills are submitted to the correct insurer first. Keep copies of all records and follow your doctor’s treatment recommendations. Keeping your records organized can really help you keep track of payments and make it easier to show your damages later.

Contact A Montgomery County Car Accident Lawyer

Sorting out which insurer pays which bill, and in what order, can be confusing at a time when you should be focused on your recovery. Schedule a consultation today by contacting us.