Medical Bills

“Charges must be reasonable…”

Medical Bills


Personal injury claims are fraught with pitfalls, but perhaps no scenario is more commonly frustrating to claimants and their attorneys than deliberately missed Timely Filing Deadlines or TFD’s. Private health insurers and government back health insurance providers such as Tricare, Medicare and Medicaid all dictate that a medical provider must submit medical treatment bills within a certain timeframe. If the healthcare provider fails to submit the bills during this window, the provider risk losing its right to reimbursement from the insurer for any bills not submitted before the TFD.

The logic behind a TFD is obvious and understandable. Health insurers and government back insurance providers cannot be expected to pay medical bill claims to a doctor, hospital or other health care entity years after treatment. Auditing the bill for authenticity and accuracy, as well as the basics of maintaining a balance sheet demand that medical bills be submitted in a timely manner.

Under most scenarios medical providers submit medical bills to private health insurers or government insurance providers in advance of the timely filing deadline. Private insurance usually allows for several months, and government health insurance can be billed much later. The problem occurs when the medial provider finds out that your injuries may give rise to a personal injury claim, such as those that occur from a car accident. At this point, medical providers often start to anticipate that your personal injury recovery, may far exceed the reimbursement reduced payment rates the medical provider can expect from the health insurance carrier or provider.

Armed with the statutory power to attach a medical lien to your personal injury claim, some medical providers will choose not to bill health insurance and wait for you to complete your personal injury claim. This is a curious and risky strategy by medical providers, as they often have no indication of the amount of insurance coverage or defendant assets that are available to address the outstanding medical bills. However, this in of little comfort to personal injury claimant who is still liable for the unpaid bills.

Combating hospitals and doctors armed with medical liens takes not only knowledge of various health care insurers and different types of insurance coverage, but also an understanding of reimbursement rates, CPT codes, medical lien statutes and the legal options and rights available to patients. We strongly recommend that if your medical provider is refusing to bill your health insurance provider, you call an attorney immediately. Time is truly of the essence.

Bills for Minors?

Injured minors are obviously not responsible for medical bills, but this can create a curious dilemma for their personal injury claims. Minors can have until age 20 to bring a claim, but their parents or guardians normally have only two years to seek reimbursement for medical expenses.

Bills in Bankruptcy?

In some cases your personal injury medical bills can be discharged (i.e. written off) during bankruptcy. In other cases the bills must be paid, as you have waived your right to forgo payment from your settlement. Payment is largely determined by the timing of your bankruptcy petition.

What are CPT Codes?

These codes indicate what services your health care provider performed. Correct coding is extremely important because it not only creates a record of what treatment you received, but also determines the cost of treatment and reimbursement rates paid by health insurance.