According to the most recent statistics from the South Carolina Department of Public Safety, a traffic accident occurs every 3.7 minutes. In 2020, over 30 car accident fatalities occurred in Rock Hill alone. Car accidents are disruptive, resulting in injuries and medical bills, and in most cases, a health insurance company pays for your bills. In other instances, your insurance plan may fall short.
South Carolina is considered an “at-fault” state. This means that the at-fault driver is responsible for all damages stemming from the accident. However, because liability payments are determined by fault, you won’t receive a settlement or payout until liability has been determined or established. If your health insurance company doesn’t pay for your medical treatment, you will have to pay out-of-pocket. However, other options are available to you, depending on your insurance.
Why Would My Health Insurance Claim Get Denied?
Health plans are vast and vary across insurance companies, and are usually specific to the person carrying the insurance. No matter the health plan, it’s common to pay a co-pay at the doctor’s office, but unfortunately, sometimes, we pay far more than we expect for the actual services we receive.
There are a few reasons why your health insurance claim could get denied. The most common reason is that insurance companies do not believe that the treatment you are seeking is medically necessary. Other reasons for denial include:
- The provider is not in-network
- You have reached your maximum benefit limit
- You have not met your deductible
- The care you received is not under your covered services or in your health plan
- Your health care provider did not get prior authorization for your treatment
- The treatment is the result of a third party’s negligence
If your health insurance claim is denied, you will likely have to pay for the treatment out-of-pocket. You may be able to appeal the decision, but this can be a lengthy and complicated process.
Personal Injury Protection/Medical Payment Coverage
Personal Injury Protection (PIP) and Medical Payment Coverage (Med Pay) are optional types of car insurance that can help pay for your medical bills if you are injured in a car accident, regardless of who is at fault. South Carolina does not require drivers to have PIP or Med Pay, but they can be helpful if you do not have health insurance or if your health insurance has a high deductible.
PIP and MPC can help pay for:
- Ambulance fees
- Lost wages
- Funeral expenses (in some cases)
- Office visits and other services
If you don’t have Med Pay or PIP insurance, your next best option may be to negotiate your medical bills with insurance and health care providers. You can work with them to negotiate an interest-free payment plan, a discount for paying the balance in full, or another solution to help you pay your bills without them being sent to debt collectors and damaging your credit.
You can also contact your Insurance Commissioner. Each state has an Insurance Commissioner who is responsible for overseeing insurance products within the state. You can find South Carolina’s by visiting the National Association of Insurance Commissioners website.
Appealing Your Medical Bills
If you cannot reach an agreement with your health insurance company or the provider, you can appeal the decision. A study done by the Government Accountability Office found that appeals across numerous states resulted in reverse rulings in 39 – 59% of cases. However, this process can be complicated, so it is important to have all the necessary documentation. You will also need to file your appeal within a certain time frame, so be sure to act quickly.
If you have any questions about your health insurance or medical bills, our experienced personal injury attorneys in Rock Hill can help. Give us a call today for a free consultation.
Contact an Attorney at The Law Offices of Jason E. Taylor
If you have been in a car accident in Rock Hill and are worried about how you will pay for your medical bills while your case is pending, we are here to help you. At The Law Offices of Jason E. Taylor, our car accident attorneys in Rock Hill are experienced in helping car accident victims get the medical care and coverage they need.