Interesting Information

HOW CAN I OR MY ATTORNEY OBTAIN MY MEDICAL RECORDS?

You, as the patient, are entitled to a copy of your medical records whenever you request same. Most providers require the request to be in writing and usually do not charge the patient when the records are provided directly to you. However, when records are requested by your attorney, the facility charges the attorney’s office for those same records. Why? Because most providers believe it is the attorney who is paying the cost of the records (because she is the one requesting same) and so the health care provider charges.

However, this is not true. Washington law and the rules of conduct do not allow an attorney to absorb costs advanced. What that means to the client is that even thought the attorney’s office advances the funds to pay for the records, the client must eventually pay the attorney back. Thus, the client is ultimately responsible for paying for their own records.

For many years providers have charged a clerical fee and a per page fee, per Washington Law, to compensate the provider for the time expended to copy records. When records were hand written, and kept in a file, somebody had to take then out of the file, put them on the copy machine, stand there to make sure they all copied, and then put those copies in the mail. The clerical and per page fee was to cover the staff person’s time.

In 2009, the federal government enacted the HiTech Act which specifically addressed copy charges for records that are created and/or stored electronically. Although this act was enacted several years ago, it has just recently be put into practice.

The HiTech Act states that if the records are either stored or created electronically then the cost to reproduce those (putting them on disc or sending via email) is minimal. How long does it take somebody to send an email? Or to .pdf a file and download it to disc? A few minutes at most. The federal government enacted this law to discourage health care providers who were charging over $1.00 per page plus a $25 clerical fee to ‘copy’ records that were never ‘copied’. I think another reasons was to discourage printing electronic records – and to save some trees!

Unfortunately, this means that health care providers can no longer make money on copying records. They can only charge the reasonable amount that it cost them to actually have a staff person ‘copy’ the records. If they pay their staff $15 an hour and it takes less than five minutes to download the records – the fee should be $1.25 plus they can factor in the cost of the ink, paper, etc. Under the HiTech Act record that once would cost my client hundreds of dollars are now reproducible for a few cents on the dollar.

There has been a lot of resistance from the medical community to the HiTech Act as they are losing a lucrative income stream but if you know about the Act you can persist in obtaining access to YOUR medical records for a nominal charge.

If you want to know more about the HiTech Act and how you can obtain a copy of your medical records you can go to the Department of Health and Human Services website:

http://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/index.html

WHY SHOULD I WORRY ABOUT MY MEDICAL BILLS?

THE COLLISION WASN’T MY FAULT!

When you are injured in a motor vehicle collision, or are struck while a pedestrian or bicyclist, if there is applicable PIP coverage, your medical bills will be paid by the PIP carrier (for the definition of PIP, see the insurance section of this website). If there is no PIP coverage, the providers must bill any and all applicable health insurances. Even if the collision was not your fault, the at-fault carrier will not pay for your medical bills as they are incurred.

When health insurance gets billed, the provider takes a contractual write off and receives a pre-designated rate for reimbursement. Any remaining balance will be your responsibility. This means you have to pay for your co-pays and cover your deductibles at the time of service.

For example, if the bill is $129 and the write off is $30, the balance is $99. Of that $99, your health insurance pays $79.20, leaving you with a balance of $19.80. This example only applies if your deductible has been met. If it has not, then the example changes. The bill is $129 and the write off is $30, leaving you with a balance of $99. Or, under some plans, if the deductible is not met you are responsible for the entire amount.

You must pay your co-pay and cover your deductible otherwise your provider can, and likely will, send you to collection. For the most part, chiropractic and massage therapy offices are more inclined to hold a balance until the settlement of your case, however, some providers will not. In my experience all radiology, hospital, medical clinics, and acupuncturists will not hold the balance. There is nothing you can do to prevent your account from being sent to collection except make payments or getting an experienced personal injury attorney involved.

Many times an attorney can work with the providers to hold the balance until settlement or to at least accept small payments on the account. When choosing a personal injury attorney it is important that you find one who has established a working relationship with local providers.

Remember, if your account is sent to collection, it will reflect on your credit report. An experienced attorney can help you avoid collection actions in most cases.

TWITTER, FACEBOOK, IINSTAGRAM – Just don’t do it!:

I know many people cannot live without social media, whether that is posting on Facebook where you are eating dinner, following someone on Twitter, or posting photographs on Instagram or Snapchat. Most of the time if you do this, it is harmless.

HOWEVER, after you are involved in a motor vehicle collision or receive an injury where you seeking compensation, these types of posts can damage your right to recovery.

If you don’t already realize it, almost everything that you post on the internet can be obtained by others. Even if you delete your Facebook photo or your account is ‘private’ it is NOT unaccessible. Insurance carriers have people who can access the information and, if you are in litigation, the defense has a right to ask for and receive information about what was posted as it could be relevant to your claim.

Insurance companies often search the web for information about you during the claim process and especially if you are in litigation. On more than one occasion a client of mine has had to explain about a post, comment, or photo found by the insurance adjuster, or defense counsel, on the web. You do not want to be in that position.

Do not post anything about the collision – no photographs, no descriptions or accounts of it, and definitely no opinions about fault or the conduct of the other driver. Do not post anything after the collision about what you are doing, where you are going, or who you are with until your claim has resolved and you will have a better chance at a full recovery.

Also, while your claim is active, ask your friends and relatives not to post comments about you or your life or tag you in a photograph.

IF YOU DON’T HAVE PIP USE YOUR HEALTH INSURANCE:

If you don’t have PIP and you are injured in an automobile collision you can and should use your health insurance to cover your bills.  That seems obvious and easy – until you try it.

In today’s market of discounts and contractual fee agreements the health care provider’s bills are being drastically reduced when they are under contract with a health insurance carrier.  This is even more so with Medicare and Medicaid.

If your provider has a contract with (or is a preferred provider or in network) your health insurance, that provider HAS TO bill your health insurance even if the treatment is for an automobile collision.  If the provider does, not it could be in breach of contract.

The reason your provider does not want to bill health insurance is because of the drastically reduced fee agreement. For example.  If you go to the emergency room (ER) and your bill is $4,000 and you have PIP the ER will get paid by PIP $4,000.  If you have no PIP and you use your health insurance the ER will get paid a lot less, something like $500.  The rest, $3,500, has to be written off because that ER has signed a contract with your health insurance company.

So, when you come into the ER and say you are in an automobile collision and you have no PIP, the ER will want to ‘hold’ the bill until you receive your settlement from the person who caused the collision (the 3rd party) and then try to force you to pay the $4,000.

WHAT TO DO WHEN YOUR PROVIDER REFUSES TO BILL HEALTH INSURANCE:

Do not let your provider side step your health insurance.  Call your attorney and your health insurance.  You have hired a personal injury attorney to protect your interests, that includes dealing with and managing all related insurance issues.  Your attorney should be clear and insistent with the provider that it is breaching it’s contract and you (the patient) are not responsible for the full amount if the provider refuses to bill health insurance.  Your health insurance company should also assist by contacting the provider.  If the provider refuses to bill your health insurance, it may be forced to write of the balance if it is not properly billed.

Of course, keep in mind that if your provider is not contracted with your health insurance then this article does not apply.  Also, sometimes there are annual limits as to the amount paid or the number of visits allowed for a particular provider such as chiropractic, massage, or physical therapy.  Once the annual limit has been reached the provider may no longer be obligated to bill your health insurance.

FOUR THINGS TO DO AT THE SCENE:

What would you do when faced with the unexpected? Somebody just ran into your car, you are stunned, maybe in shock, and not sure what to do. The person looks nice and is apologizing. You think things will be okay – she has insurance. Even a seemingly inconsequential situation can have long term effects that you are not aware of until later.

To avoid some of the situations my clients have faced, I suggest you consider taking these steps to protect yourself and to avoid future issues. Please only do what you can in a safe manner.

Call 911. Unless there are serious injuries requiring an ambulance or first responders, a police officer may never respond. Not responding to ‘minor’ collisions is becoming the standard practice for most police agencies facing budget issues. That fact should not dissuade you from calling 911 to report the collision to put the facts on record. Give the dispatcher as much information as to what happened and the parties involved as you can. Then, if the police do not respond, you have documented the collision.

Use your cell phone. Do not leave the scene without taking a picture of the other driver, his license plate, the damage to the cars, the location of the impact (if it is safe to do so), her driver’s license, and proof of insurance.  Many times people will exchange addresses and phone numbers and get an insurance policy number then leave the scene thinking that is all they need. That is wrong. The address provided could be old, the phone number disconnected, the insurance car invalid. What then? How do you find this person? How to you get your car repaired? How do you make a claim? You sometimes can’t. It will only take a few seconds to snap some pictures that will identify the person and give you enough information to make it easy to find that person in the future.

Look for witnesses. Even if nobody stops, look around for people who may have seen the collision. Of course this is easier if the collision occurs on a city street. Look at the surrounding businesses or houses. Was somebody in the yard? In the window of the shop? Don’t hesitate to ask – especially if the other driver is not willing to contact insurance or wants to settle with you right now.

Put it in writing. If you have the time and it is safe, get the other driver to sign a statement that he is at fault for the collision. It can be written on anything – an envelope, a cardboard box, even a napkin. Make a brief statement about what happened (Mr. Smith ran the red light and hit Mrs. Brown’s car in the intersection of 1st and Main) then have the other driver sign and date it. This will help preclude Mr. Smith from telling his insurance carrier a different version of the facts later.

I BET YOU DIDN’T KNOW:

You don’t have to give a recorded statement to your own insurance company unless it is written in the policy. (There is only one carrier that has it written in the policy that I am aware of.) You do not want to give a recorded statement because most of the time it is given at an inconvenient time – you are in a hurry, you are not thinking of what is being asked, you are on pain medications, you are at work. The recorded statement is another tool your own insurance carrier will likely use against you later.

You do not have to give a statement to the other insurance company. You should be very careful when talking to the other insurance company – less is best. If there is a police report there is no need for you to tell what happened, it has already been documented.

You should always carry PIP coverage. PIP is not like health insurance. It has no deductible, co pay, or number of visit limitations. It has to be used within a certain period of time and you can only use as much as you purchased but you can go to any type of provider. There are no preferred provider lists or in network requirements. It is also relatively inexpensive! Read more about PIP under insurance coverages.

You do not have to sign an authorization for either insurance company that is not specific to the collision. You should not sign an authorization for the at-fault carrier under most circumstances. If you have PIP then you will need to give one to your own insurance carrier. However, read it carefully as it will most likely be a very broad authorization that allows the insurance carrier not only to obtain medical records related to the collision but unrelated and prior records as well. It may also allow the insurance carrier to obtain employment, social security, and workers compensation files.

You should not rely upon your insurance carrier to do the right thing. Insurance is a business. It is not there for your protection, it is there to make a profit. Your insurance carrier will usually do the right thing only if you know how to make it do it.

GLOSSARY:

  • 3rd Party: This is the insurance company that insures the person who hit you.
  • Diminished Value: The different in the value of your vehicle prior to the collision and the value of your vehicle following the collision.
  • Essential Services: Daily tasks that you are unable to do per the instruction of your treating physician and are required to hire help for. For example, clean the house, garden, home repairs/maintenance, or grocery shop.
  • FRA: Financial Responsibility Agreement. Allows your provider to hold your outstanding balance until the time of settlement. Although the FRA is in place, some providers will require you to make a small monthly payment throughout the course of treatment.
  • General Damages: Monetary recovery for injuries suffered (such as pain, suffering, inability to perform certain tasks, loss of enjoyment of life activities, etc.) for which no exact dollar value is calculated.
  • Liability: Being responsible for something.
  • Lien: The collection department for PIP or health insurance. They require repayment for the payments made to your health care providers.
  • Loss of Use: The inability to use your vehicle following the collision until either repairs are completed or the total loss amount is determined.
  • Lost Wages: Calculation of the time missed from work by your hourly rate.
  • PIP: Personal Injury Protection. This benefit is provided through your insurance company covers your collision related medical bills until your benefits have exhausted (maxed). This is a “loan” and therefore, must be repaid at the time of settlement.
  • Policy Limits: The maximum amount allowed for payout/settlement through either your insurance company or 3rd party.
  • Primary Insurance: Insurance that pays first.
  • Secondary Insurance: Insurance that becomes effective and beings paying after your primary insurance has exhausted.
  • Special Damages: Damages which can include medical bills, repairs, replacement of property, and loss of wages. These damages can be calculated based upon a bill, receipt, or other form of documentation.
  • Total Loss: A determination, after an appraisal, that the cost to repair your vehicle is more than the fair market value.
  • Tort Feasor/At-Fault Party: The person driving the vehicle who hit you.
  • UIM: Underinsured motorist. If the tort feasor has low policy limits that are not enough to fully compensate you for your injuries, you would turn to the underinsured motorist coverage through your own policy to obtain a larger settlement.
  • UM: Uninsured motorist. If the tort feasor does not have insurance, you would turn to the uninsured motorist coverage offered under your own policy. This coverage allows you to obtain a settlement for the injuries sustained in the collision.