Limitations of Med-Pay Insurance Coverage

Though necessary for your protection in the event of a serious and life-changing motor vehicle collision, Med-Pay insurance coverage for car accidents has some notable limitations, and consequently, it is not a perfect solution to meet your immediate financial needs to pay emergency and follow-up medical treatment bills. One significant limitation of Med-Pay coverage is that many hospitals are reluctant to accept your Med-Pay coverage as a form of prepayment before rendering necessary treatment to you.

These hospitals have experience with insurance adjusters “haggling” over the medical bills, so the hospital administration prefers not to deal with Med-Pay coverage. Thus, you may have to use your own health care plan or personally pay cash to obtain such treatments, and thereafter seek reimbursement for your “out-of-pocket” expenses from your Med-Pay coverage. Some injury victims have Medicare/Medicaid protection, which hospitals accept (but don’t prefer), because the federal reimbursement rate under Medicare/Medicaid is lower than your individual or health care coverage rates. In essence, you are financially penalized for being a financially responsible person.

One way to overcome the problem of getting your own Med-Pay coverage accepted by the hospital is for your lawyer to write a letter of protection to the hospital so that you get the care you need and deserve. Your lawyer will ensure that when the case is resolved, the hospital will get paid a reduced amount out of the settlement in conjunction with your Med-Pay coverage.

Another limitation of Med-Pay coverage, which is akin to the previous limitation, is how the insurance adjuster has the authority to reject part of your treatment for payment under the auspices that the treatment was not necessary. So, you are on the hook to pay for these bills, even though you have medical payment coverage to pay for them. Again, legal counsel can normally get this problem favorably resolved, but the insurance adjuster will take advantage of unrepresented people, which can make life for such individuals more difficult.

Finally, most Med-Pay coverage terms require the medical treatment to be concluded within two years from the date of the auto collision. Sometimes the injured person waits too long to get treatment or diagnostic tests, which otherwise should have been covered by Med-Pay coverage. When the coverage period lapses, the insurance adjuster terminates any further obligation to pay any more medical bills, even though the coverage has not been exhausted.

Finally, although your deadline for depleting your Med-Pay coverage is generally two years from the date of the collision, you may not realize the urgent need to obtain all the treatment you need now, and not wait till near the end of these two years. Most Med-Pay coverage adjusters take a dim view of your seeking medical attention near the end of the two years on the basis that you should have healed by then, and any new treatment cannot be related to your auto collision. So, if you wait until near the end of the two-year statute of limitations to hire a lawyer, the Med-Pay adjuster may not accept the medical bills you incur later on. By the time your lawsuit is filed to preserve your claim, any portion of your Med-Pay coverage that has not been used will likely be terminated by the adjuster. This means that you get stuck with paying all the medical bills you incurred, even though you paid for such medical payment coverage.

As you can see, med-pay coverage offers some protection, and some protection is better than no protection. But, med-pay coverage will not pay for the lost wages and pain and suffering you have experienced. Those losses must be paid by the parties responsible for your injuries.

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