Many people in Massachusetts deal with personal injuries from car crashes, subway accidents, slip and fall incidents and other types of incidents. Hefty medical bills are common after such injuries. Navigating them can be very stressful and complicated.
It is helpful to understand who bears responsibility for these bills while the fault-finding investigation or settlement talks are ongoing.
Injured party
The primary responsibility rests with the injured party. Essentially, the injured party must seek medical treatment and shoulder the associated costs.
Health insurance
People often rely on their health insurance policies to cover medical bills resulting from accidents or injuries. Health insurance providers may pay for medical treatments, procedures and services. However, health insurance commonly does not cover certain expenses. These out-of-pocket expenses can include:
- Co-payments for certain services, such as doctor visits, prescription medications or emergency room visits
- Deductibles that individuals must pay out-of-pocket before their insurance coverage kicks in
- Coinsurance, where the insured meets the deductible but is still responsible for a set percentage of costs while the insurance company covers the rest
- Out-of-network services, which typically have higher deductibles, co-payments and coinsurance rates
- Medical equipment and supplies, in which coverage may be minimal or require prior authorization
These expenses can be considerable.
Benefits and subrogation
In cases of multiple insurance policies, such as auto insurance or workers’ compensation, the coordination of benefits is important. Insurance companies must determine the order in which policies will contribute to covering medical expenses. Additionally, some insurance policies include subrogation clauses. They allow the insurance provider to seek reimbursement from settlements or judgments obtained by the insured party.
As individuals try to recover physically and emotionally from their injuries, they may still have to pay medical bills. Understanding their responsibilities and rights may reduce stress and help with getting fair compensation.