Being involved in a car accident can quickly become an expensive ordeal, especially if you suffer injuries that require medical treatment. Whether it’s a broken bone, a soft tissue injury, or a severe brain or spinal cord injury, getting the treatment you need can be costly. Thankfully, you have options for covering the cost of this treatment. Your health insurance is one of these options.
However, getting your insurance provider to cover your healthcare costs may not be as straightforward as you’d hope. A San Antonio car accident lawyer can help you understand your coverage and explore your options for seeking compensation to minimize your out-of-pocket costs after a collision.
Factors Affecting Coverage
Several factors will affect the extent to which your health insurance will cover the costs of your car accident injury treatment.
Your Health Insurance Plan
The first factor to consider is the details of your specific health insurance plan:
- Type of Plan: Different plans come with varying coverage levels, which can significantly affect your out-of-pocket expenses. Some plans have better benefits for emergency care or specialist visits. Others may have limited networks restricting which doctors or hospitals you can visit. If your plan requires pre-authorization for specific treatments or has out-of-network restrictions, this could impact how easily you receive care after a car accident.
- Deductibles: Your deductible is the amount you must pay out of pocket before your health insurance kicks in. If you have a high deductible plan, you may need to cover a significant portion of your medical expenses before your insurer begins to contribute.
- Copays: You’ll likely have copays for doctor visits, emergency room treatment, and specialist care. The amounts vary by plan but can add up quickly after a car accident.
- Exclusions: Many health insurance plans also include exclusions, meaning they won’t cover certain treatments or injuries. For example, some plans may not cover alternative therapies like chiropractic care, which is common for soft tissue injuries after car accidents. Understanding these exclusions is crucial to know how much of your medical care your insurer will cover after an accident.
State Laws
Texas operates under a fault-based car insurance system. This means that the driver responsible for causing the collision is liable for covering the resulting losses.
After a car accident, the at-fault driver’s insurance typically pays for medical bills, lost wages, and other related expenses through their liability coverage. However, this process can take time, as it involves investigations and negotiations with the insurance companies. During this period, you may need to rely on your health insurance to cover your immediate medical needs.
Texas also requires that all vehicle insurance policies include personal injury protection (PIP) coverage, which is designed to cover medical expenses, lost wages, and other costs regardless of who was at fault for the accident. While insurers must offer PIP insurance, drivers aren’t required to have this coverage. You must reject PIP coverage in writing if you choose not to carry it.
PIP coverage can provide faster financial relief for medical costs than waiting for a liability claim to settle. If you have PIP insurance, it can work alongside your health insurance to reduce the amount of out-of-pocket expenses you’ll face after an accident. This can be especially useful for immediate treatments and recovery.
Your Specific Injuries
The nature and severity of your injuries will play a significant role in how much your health insurance will cover after a car crash. Minor injuries like bruises and soft tissue damage may only require a few doctor visits or physical therapy sessions. This could be mostly covered by your health insurance, depending on your plan’s benefits.
However, more severe injuries – such as broken bones, spinal cord injuries, or traumatic brain injuries – often require extended hospital stays, surgeries, and specialized care. These treatments can quickly surpass your health insurance limits or trigger higher out-of-pocket costs due to deductibles or coverage caps.
The Accident Circumstances
The circumstances of the crash may also affect your ability to claim benefits. If you were driving recklessly or violating traffic laws when the accident occurred, some health insurance plans may have clauses that limit or deny coverage for those incidents. Understanding these specifics will help you plan for potential costs.
How Health Insurance Works in Car Accident Cases
After a collision, your health insurance typically serves as the first line of coverage for medical treatment. But the process may be more complicated than for other types of injuries. Understanding these steps can help you get the coverage you need while awaiting a final settlement from the at-fault driver:
- You Seek Immediate Treatment: If you are injured in a car accident, the first step is to seek medical attention. Whether you visit an emergency room, urgent care, or a primary care physician, you’ll provide your health insurance information to cover the initial costs.
- Your Health Insurance Usually Pays First: In most cases, your health insurance will pay for your medical care upfront, subject to your deductible, copays, and coverage limits. However, if you have personal injury protection (PIP) or medical payments coverage on your auto insurance policy, they may apply first before your health insurance kicks in.
- Your Insurer Seeks Repayment Through Subrogation: If another driver caused the crash, your health insurance provider may seek reimbursement through a process called subrogation. This means your insurer will pursue the amount they paid for your care from the at-fault driver’s insurance. This process helps reduce your out-of-pocket costs in the long run. Otherwise, you may have to repay your health insurance company with the money you receive from a personal injury settlement.
Do You Have Specific Questions? Contact Our Law Firm Today
Our skilled car accident attorney has over 30 years of experience handling personal injury cases. In that time, our team has helped thousands of injury victims get the compensation they needed to cover their medical expenses, lost wages, and other losses. We have secured several six- and seven-figure awards for our clients, including a $1.6 million settlement for a severe car crash.
With our firm, you can expect personalized attention to your unique needs and high-quality legal representation. Past clients say you can look to us if you want an attorney who will “not only will fight hard for you, but will also treat you as a person and not just a dollar sign.” Reach out to our San Antonio office today to learn more.
Or
