I was in a car accident that was not my fault. In the accident, I was whiplashed. As a result, I have chronic neck pain and headaches. After many months of negotiating, we have arrived at a settlement figure. Part of the settlement is to cover future medical bills. My question is can a health insurer take money from my settlement for future medical bills? I’m worried about parting with too much of the settlement money. I’m still able to work, but things could change.
Dear Future Tense,
The health insurer can take money that it paid for your care, and that the settlement has repaid you. So, if your plan paid for a hospital stay and the settlement includes money for that same hospital stay, then you have to repay your health plan.
The insurer cannot take money from you now for medical bills that have not arrived yet. But when those bills do arrive, they will ask if any other party is also responsible for your costs. This is normal, everyday claims processing: plans are always looking to see if someone else should be paying a particular bill. Whether your plan can refuse to pay for your care related to your injury depends upon your plan’s Summary Plan Description (SPD). Have your attorney review this and advise you on what to do with your medical bills.
If you think you might qualify as “disabled” by the Social Security Administration in the next 30 months and your settlement is at least $250,000, your settlement needs to be reviewed by the Centers for Medicaid and Medicare Services (CMS). Your attorney should be on top of this.