Handling Your Own MedPay Claim



Why should I handle my own MedPay?

After a car accident, you are dealing with a million different concerns, and paying off your medical bills may be the last thing on your mind. Often, a doctor treating you for accident-related injuries may tell you that they will just get paid directly by your auto insurance through Medical Payments coverage. This may sound like an easy option for you, but that is not always the case. The bottom line is that collecting your own MedPay gives you the flexibility to handle your outstanding medical bills and liens in a way that allows you to manage your own budget.

Can’t my doctor send their bills directly to my adjuster?

The biggest question everyone wants to know when it comes to MedPay is, “Who gets the MedPay money?” The answer is not a simple one! In some cases, your medical facility will send their billing directly to the insurance adjuster if they know you have MedPay available or they will attempt to determine whether your car insurance carries MedPay. In those cases, the adjuster will simply cut a check to the medical provider to cover the balance incurred. Great, right? Not always.

Imagine you have $5,000 in Medical Payments coverage available to you and have accumulated $8,000 in medical expenses, $2,500 of which comes from chiropractic treatment. Your chiropractor knows you have an open MedPay claim and is sending their bills directly to the MedPay adjuster so that you don’t have to pay up front or bother with bills and records. The MedPay adjuster simply pays the chiropractor and you don’t have to worry about a thing, except for the other $5,500 medical expenses. Now you only have $2,500 left available in MedPay coverage and the only facility that has been paid off is your chiropractor.

Certain billing providers are far more lenient than others when it comes to paying account balances. For example, many local ambulance or EMS services have the ability to garnish your wages if you don’t pay within a couple months, according to N.C. Gen Stat. §§44-49 and 44-50. That ambulance bill may have been a better balance to submit to the MedPay adjuster if you know the chiropractor offers a monthly payment plan or may be willing to treat you on a lien basis. For more information about medical liens, visit our Medical Liens section.

Hospitals are another facility that want their money paid back as soon as possible and will send balances to collections if left unpaid. Most medical providers will work with you to set up a minimum monthly payment plan, but if you have a huge surgery bill, that monthly payment plan may be more than you can afford each month. Having $5,000 in MedPay reimbursement to apply to that balance could make a significant difference.

Once a settlement has been reached, certain medical providers may be willing to negotiate the balance owed to them. For example, if you owe a chiropractor $3,200 for treatment rendered for your personal injury case, you could ask them if they would be willing to accept a lesser amount (such as $2,900) and in return, you will pay them the amount they agree to in full. Sometimes doctors, who suspect it could be months until they get any payments from their clients, much less the full $3,200, will accept this reduction as the full and final balance. In these cases, having all of your medical payments reimbursement funds available can allow you to negotiate appropriately. If you let the doctor request the MedPay money themselves, you can bet that they are going to submit the entire $3,200 balance to your Medical Payments insurance adjuster.

The best way to manage your incurred medical expenses is to keep a running list of your various medical appointments and the correlating balances accumulated. Talk to each provider about setting up a monthly payment plan and investigate which of your medical providers may be more flexible about your bills. Once you have determined the best way to manage paying back your balances, submit whichever bills you feel are best for your case to the insurance company for reimbursement from MedPay. For information on MedPay reimbursement, see our article Submitting MedPay Reimbursements.

What if I am treating on a lien basis?

If your medical provider has already notified your MedPay adjuster that there is a lien (or assignment of benefits) on file, you may run into a situation in which the adjuster will insist that they must honor the assignment of benefits or lien on file. This means that they are obligated to pay the medical provider with a lien first. Remember that, as mentioned above, this will diminish the amount of MedPay funds available and may prevent you from paying back a much larger bill or perhaps a bill to a medical provider that will not work with you on a payment plan. If this happens, consider speaking to a local personal injury lawyer about what options may be available to you.

An assignment of benefits or medical lien is often issued by a chiropractor but may also be claimed by a local hospital, physical therapist or even ambulance services. Sometimes there is nothing you can do if a medical lien has been issued, but in some cases, you may want to check the billing practices of each provider if you are planning on getting regular treatment. Typically, language surrounding liens and Medical Payments coverage will be described in their intake paperwork. Before you sign anything, make sure to ask the provider questions such as, “What exactly does this mean?” and, “Will you be attempting to contact my MedPay adjuster?”

A good way to try to catch this before it happens is to speak to your MedPay adjuster and let them know that you will be submitting bills and records yourself and that you do not want them to make any reimbursement payments without first contacting you. While you are on the phone with the adjuster, ask them about their company’s policy concerning assignment of benefits and medical liens, as each insurance company may handle this process differently depending on the wishes of the client.



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