Who Covers Medical Expenses After a Pedestrian Accident?

medical expenses in pedestrian accidentPedestrian accidents often result in severe injuries and all the challenges that go along with them-including large medical bills. From the moment you receive ambulance transportation or treatment in a hospital emergency room, you will begin accruing medical bills. In many cases, those medical bills may grow significantly higher than anticipated, leaving you in a financial bind.

Who has to cover those medical expenses following a pedestrian accident?

Ultimate Responsibility for Pedestrian Accident Medical Expenses: The Injured Party

As the injured party, and the one receiving medical services, you will have to take ultimate responsibility for any medical costs you face after an accident. Regardless of what type of care you receive or who caused your accident, you will need to take care of those payments or face the legal and financial repercussions of nonpayment.

However, the fact that you bear ultimate financial liability for the medical care you receive after a pedestrian accident does not necessarily mean you cannot decrease your medical bills or receive assistance covering those expenses.

Insurance, Liability, and Pedestrian Accident Bills

After a pedestrian accident, auto insurance can provide the first vital line of protection to help you decrease your overall medical costs and make it easier to handle the costs of your medical treatment.

Insurance often covers the expenses of a pedestrian accident. If you have questions about your coverage, talking to a lawyer can give you a better idea of what policies might apply to your specific case and how to ensure that you receive the maximum value from your coverage.

Personal Injury Protection Insurance

If you carry an auto insurance policy, you may have a type of coverage known as personal injury protection insurance. Personal injury protection insurance, or PIP coverage, helps provide a layer of protection for medical costs after an auto accident, regardless of who caused the accident.

You may often claim compensation through your PIP coverage if you caused the accident or not. However, if another driver’s negligence caused your pedestrian accident, you may also claim compensation through that driver’s coverage in some circumstances.

Your PIP coverage may extend to cover the medical costs associated with pedestrian accident injuries. Have an attorney review your PIP policy to help you understand what coverage you should expect following your accident. Generally, PIP coverage will pay out up to the maximum value of the policy, minus your deductible amount. A lawyer can help you evaluate the coverage you may have and how it will impact your ability to pay your medical bills after your accident.

Your Medical Insurance

If you carry personal medical insurance, either through your private policy or an employer, your medical insurance may offer a great deal of assistance with your overall medical bills.

Medical insurance helps decrease the out-of-pocket costs many people face in association with significant injuries, including injuries caused by another party’s negligence. However, medical insurance policies often include some complexities that can make it difficult to determine how much coverage you have in specific areas and, therefore, how much you may still need to pay out-of-pocket for your medical care.

You may want your lawyer to review your insurance coverage to understand better what assistance your policy may provide for various aspects of your medical care.

As you create your treatment plan and determine how you want to manage your bills, your coverage has several critical elements to consider.

In-Network Vs. Out-of-Network Coverage

Your insurance company works closely with providers that the company will designate as in-network: those with whom the insurance company has an established relationship and whose services the insurance company will cover at a higher rate. In-network providers will often cost you less, so that can make a big difference in your healthcare costs after a pedestrian accident. You may have larger copays and a separate deductible for out-of-network providers.

Talk to your insurance provider about in-network providers for the services you need. In some cases, you may have difficulty finding in-network providers who can assist with certain aspects of your care. However, working with your insurance company can help you determine how much you can expect to spend on your healthcare needs and what steps you can take to maximize your coverage under your policy.

Copays, Deductibles, and Out-of-Pocket Maximums

Your insurance coverage will include several key elements that determine how much you need to spend on your medical care after a pedestrian accident. Make sure you understand:

Copays: The amount you will have to pay for any medical procedure. For example, you may have a $50 copay every time you see a specialist, or you may have an 80/20 split with your insurance company, in which you will have to pay for 20 percent of your treatment, while the insurance company will cover the other 80 percent. You may need to know the copay amounts for various services that you will receive throughout your recovery, including visits with specialists, hospitalization, and medical equipment.

Deductibles: The amount you will have to pay before your insurance coverage kicks in. Your deductible amount includes the amount you must take responsibility for before your insurance covers the cost of any treatment. Following a severe pedestrian accident, you may meet your deductible reasonably quickly as the cost of medical treatment adds up.

Out-of-Pocket Maximum: The maximum amount you have to pay for medical care over a calendar year. Take a look at the coverage offered by your insurance policy and how much that out-of-pocket maximum will impact your ability to pay for your care.

Specific Coverage Elements

Insurance policies may vary substantially on the specific coverage they offer for the various types of medical care you may need throughout your recovery. As you create a treatment plan with your doctor, you may want to look at the types of coverage you have for the elements of care that you will most likely need to make a full recovery.

Long-term care: Your insurance policy may offer a specific amount for long-term care or may have a specific length of time that you can stay in a facility or receive in-home care for your injuries. Make sure you understand the limits of your policy and how much coverage you have so, if possible, you can avoid accruing significant medical bills outside your policy.

Durable medical equipment: Your policy may have a separate section for durable medical equipment or a specific process that you must go through to receive approval for that equipment. For example, you may have to have a specific prescription from your doctor or have your durable medical equipment needs reviewed by the insurance company before they approve particular types of equipment. Working closely with your doctor and your insurance company can make it easier for you to receive coverage for those vital elements of your care.

Physical/Occupational therapy: If you suffered severe injuries in your pedestrian accident, including injuries like spinal cord injuries, amputation, or multiple broken bones, you might need to go through physical or occupational therapy to help you regain your independence. Physical therapy focuses on gaining strength and flexibility in the injured area or retaining it in other areas of the body while you recover. Occupational therapy helps you learn how to work around your new physical limitations and maintain your independence as much as possible. Those sessions can prove vital to your overall recovery. However, your insurance policy may assign limits to the number of sessions covered each calendar year. Understanding those limitations can help you plan your therapy accordingly.

Insurance Approval

In some cases, particularly if you have complex medical needs following your pedestrian accident or need specific types of care, you may need to have your care approved by the insurance company before undergoing a procedure to ensure it is covered.

Your insurance company will often have a specific process for that approval that you must follow to receive coverage. If you fail to comply, you may not have the coverage you need for your medical care, which may leave you paying out-of-pocket for those services.

Insurance Coverage and Your Pedestrian Accident Claim

When you receive coverage through your medical insurance company for treatments related to an accident for which someone else bears liability, including a pedestrian accident, your insurance company may seek compensation through part of your claim.

Talk to your lawyer about whether your insurance company may have the right to put a lien on your pedestrian accident claim and what protections you might have against it.

The Driver’s Insurance Company

When you suffer injuries in a pedestrian accident, you may have the right to pursue compensation through the insurance company covering the driver who caused your accident.

Most drivers carry liability insurance that provides compensation when they cause an accident that injures another party. A lawyer can help you understand the specific terms of the driver’s insurance policy and how they may pertain to your particular case.

A pedestrian accident injury claim can help you receive vital coverage for your injuries but does not require the insurance company or the liable party to pay for those medical bills directly. Instead, you will make arrangements to cover those medical bills then seek compensation through a personal injury claim against the insurance company.

Alleviating Your Medical Costs

Medical costs can grow higher than you anticipated after a severe accident. Even with compensation through an injury claim, you may find yourself struggling to cover all your medical bills. Fortunately, you have several options for alleviating some of those medical costs.

Check out Provider Programs

Many medical providers offer programs that can help alleviate medical costs for people who struggle, for any reason, to pay. You may want to talk to your provider about what income bracket you need to fall into or what assistance the hospital or provider may offer for your care. Look into provider-sponsored programs available to you to reduce costs.

Negotiate With Your Provider

Even if your provider does not offer direct policies that can help alleviate the cost of your medical care, consider negotiating with your care provider. Often, care providers want to receive some payment for their services, even if they cannot get the total amount of your medical treatment. They may negotiate the costs of procedures, copays, deductibles, and other amounts you have to pay out-of-pocket to alleviate the financial strain you face or make it easier for you to cover the cost of your treatment.

An attorney can help you negotiate with your medical care provider, including offering solutions that may help you decrease the cost of your treatment and allow you to keep more of the funds from your pedestrian accident claim.

Contact a Lawyer for Help With Your Pedestrian Accident Claim

If you suffered injuries in a pedestrian accident, you likely have many questions as you manage the challenge of your expenses and losses. Contact a lawyer to learn more about your specific rights following a pedestrian accident and how a lawyer can address your medical costs.