If you have been injured in a car accident, who pays the medical bills isn’t the first thing on your mind, but it’s something you’ll have to deal with eventually.
The confusion may even begin when you step into a clinic or hospital door, where billing rules may come up before a doctor has even seen you. Does auto insurance always pay medical bills after an accident? When does health insurance pay car accident bills?
Below we’ll clear up how health and car insurance work together to help you navigate the aftermath of an accident.
- The insurance that pays your medical bills depends on who is at fault in the accident and whether your state is a no-fault or tort state.
- Some urgent care and other clinics may turn away accident injuries due to third-party billing issues and may send you to the ER.
- Car insurance is primary in most cases, meaning it pays first, and health insurance kicks in afterward.
- Which pays first after an accident, auto insurance or health insurance?
- Does it matter who is at fault for the accident?
- What happens if the other driver is uninsured?
- Does going to urgent care instead of the emergency room affect insurance?
- How can you get help to deal with insurance billing after an accident?
Which pays first after an accident, auto insurance or health insurance?
When there are injuries in a car accident, the medical bills get complicated in a hurry. The laws in your state and who is at fault for the accident will largely determine which insurance company pays.
As a general rule, auto insurance is the primary insurance for accident-related injuries. That means the auto insurance company pays first and health insurance pays any remaining bills.
However, which portion of your policy pays and how long that takes depends on the situation.
Does it matter who is at fault for the accident?
If you live in a no-fault state where you must carry personal injury protection (PIP), that coverage will be primary after a car accident. You’ll file the claim with your car insurance company directly. Your health insurance, in this case, would be secondary to the PIP coverage.
“In an at-fault accident, the only coverage for bodily injury afforded under your automobile policy that you would have is medical payments and PIP, if applicable. If you're not at fault, then you still need to see if medical payments and PIP, if applicable, is coverage that is on your automobile policy, as these coverages pay regardless of fault,” says Paul Moss, founder and CEO at HeyDriver,! an online insurance agency.
However, in a fault (tort) state, the fault in an accident does matter. If you’re at fault, neither your policy nor the other driver’s policy is responsible for your medical bills (unless you have chosen to add PIP or medical payments coverage as an option.)
The other driver’s liability insurance will be on the hook for your bills if you're not at fault. However, getting that money can take some time, as even determining fault can be a lengthy process.
“If you are not at fault, your health insurance will pay the upfront expenses and then subrogate (recoup) their payments from the auto insurance of the at-fault party's auto policy liability. You should always check with your automobile company to see if you have medical payments or PIP (if applicable) coverage, which pays out regardless of fault and can cover any copays or deductibles that may apply with your health insurance plan,” Moss says.
What happens if the other driver is uninsured?
If the other driver is at fault but doesn’t have insurance, there are a few options to pay for your injuries.
First, if you have PIP, it will pay regardless of fault. Second, if you have uninsured motorist coverage, you can look to that coverage to pay your bills.
If neither of those coverages is available, your health insurance will pay your bills. You may consider suing the at-fault driver, but unfortunately, drivers without insurance aren’t likely to have the means to pay a judgment. That leaves one of your insurance plans as the payee.
Does going to urgent care instead of the emergency room affect insurance?
You don’t have to go to the ER if you aren’t severely injured. However, there are a few things to remember when deciding between the emergency room or urgent care.
An emergency room can’t refuse to treat anyone in need of care, regardless of whether they have insurance. That’s true regardless of whether car or health insurance is expected to pay the bill.
Urgent care clinics, on the other hand, don’t have the same rules. While most will see you regardless, accident victims have been turned away. Why? The clinic either isn’t set up to bill a car insurance company, or the health system has rules against working with third-party insurance (car insurance).
The reason? The clinic doesn’t want to wait for the car accident settlement to get paid for treating you. When this is the case, you may be sent to the emergency room even if your injuries don’t warrant it, resulting in a higher bill.
How can you get help to deal with insurance billing after an accident?
Depending on the situation, you may reach out to several sources of assistance to deal with accident bills. First, if you have an insurance agent, you can start there to get questions answered. Your insurance adjuster can also help.
If you get your health insurance through work, you may have someone in HR who can help you make sense of bills and speak with the insurance company on your behalf. To get help dealing with uncooperative car insurance companies, you can contact your state’s insurance department.
Finally, you may need to hire a lawyer, especially if there are questions of fault or when there are a lot of medical bills that may exceed an at-fault driver’s limits.