Personal Injury

Q. What is Med Pay?
Medical payments (Med Pay) coverage generally pays for medical costs after you are hurt in a car accident, regardless of who is found at fault for the accident.

Additionally, medical payments insurance may help pay for:

    Funeral expenses.
    Injuries you sustained, regardless of whether you were in your car or someone else's.
    Injuries sustained by your passengers.
    Injuries you sustain as a pedestrian or bicyclist after a car hits you.

Unlike liability coverage, Med Pay policy limits do not refer to the total available coverage, but instead to the amount available to each covered injured individual. That means if you, your spouse and your two children were injured in an auto accident, each of you could collect the limit amount on your $5,000 Med Pay coverage for a total of $20,000. However, your insurer won't pay the same bills under both your Med Pay and liability coverage. Also remember, your liability insurance only covers those in the other vehicle.

Med Pay insurance will not cover items such as vehicle repair or other property damage, lost income, temporary or permanent disability, or pain and suffering. Also, Med Pay is purchased on a “by vehicle” basis; this means that, if you have two cars, you must purchase Med Pay for both if you wish to covered while in either car.

Benefits and restrictions of medical payments coverage will differ among car insurance companies. Make sure that when you are comparison-shopping for your car insurance, you speak with an insurance agent from the company to fully understand the details of their medical payments coverage.

Q. Do I Need Med Pay If I Have Health Insurance?
. Med Pay is not a replacement for health insurance. Med Pay is very limited in the amount of coverage that it offers. You can expect to be allowed to purchase a maximum of $25,000 worth of coverage in Med Pay. This amount of coverage can usually cover minor to moderate injuries, but certainly not long-term care as a result of an accident. Once your Med Pay coverage is exhausted, then your regular health insurance kicks in and picks up the remaining portion of the expenses.

On the other hand, health insurance is no replacement for Med Pay. Med Pay has no deductible or co-pays, and not nearly as many coverage limitations. Med Pay pays for your medical expenses up to your Med Pay coverage amount. Nice and easy.

Med Pay is not like a health insurance option. You don’t hand an insurance card to the Reception Desk. Instead, when you come in for care, we will ask you for your insurance company name and claims address, your insurance adjuster's name and phone number, your claim number, and how much Med Pay you have. (We do not have any way of getting this information other than from you.) With this information in hand, we will send in claims to your auto insurance company on your behalf so that payments will be made directly against your balance.

Q. Is Med Pay Expensive?
. No. With all factors considered, medical payments coverage is generally one of the least expensive types of car insurance coverage. The premium for Med Pay is so small that the benefits you'd receive on just one claim could pay for decades of peace of mind.

Q. How Do I Know If I Have Med Pay?
Find the Declarations page of your auto insurance policy. You will get one of these immediately after starting your policy or upon renewing your policy. Your Declarations page will state if you have Med Pay -- and, if so, how much you have purchased.

Q. How Much Med Pay Should I Have?
Med Pay is typically purchased in thousand-dollar increments. Your insurance will pay up to the policy limit which you have purchased. The amount which you purchase will depend on the quality of your health insurance, etc. Some consideration of benefits and drawbacks to various Med Pay amounts is below:

$1,000 (or sometimes $2,000): Putting it quite bluntly, even if you have phenomenal health insurance, having only $1,000 or $2,000 in Med Pay is barely better than having none at all. This would pay for only a fraction of your emergency room costs; or, it would pay for only about one or two weeks of chiropractic care.

$5,000: In the past, $5,000 has always been the good minimum amount of Med Pay. But with the rise in health care costs, this level would probably only pay for moderate injuries which did not involve a trip to the emergency room. However, if you needed longer or more intensive care, or if you did go to the emergency room before seeking chiropractic care, $5,000 may not be enough and you may be left with out-of-pocket expenses.

$10,000: This Med Pay amount seems to be emerging as the new safe minimum. If you are in an accident and suffer mild to moderate injuries which don't require an emergency room visit and you seek primarily chiropractic care, $10,000 will likely be more than enough to cover your expenses. And even if you do have to go to emergency room, after you finish care you may still be left with little or no out-of-pocket expenses.

$25,000: There are pros and cons associated with this level of Med Pay.

Pro:  Most people's health insurance is costing more and delivering less. It seems as though each year there are more limitations, exclusions and small print. If you are involved in a very severe accident that will require longer and more intensive care, you may not be able to depend on your health insurance to give you the financial help you need once your Med Pay coverage amount is used up (aka exhausted). Therefore, having a high Med Pay amount could be very helpful both financially and physically.

Con: It is quite common for insurance adjusters (the person assigned to your accident claim to evaluate and pay bills) to be indoctrinated with insurance company dogma. One dogma goes like this: all insurance customers use the limit of whatever insurance benefits they have, whether they need it or not. In other words, your insurance company likely believes that if you have an injury and need $7,500 in care but you have $5,000 Med Pay, you will only get $5,000 worth of treatment; however, they believe that if you have $10,000 Med Pay, you will get $10,000 worth of treatment, even though you only need $7,500 worth. So if you report an auto accident claim and your insurance adjuster sees that you have $25,000 Med Pay, he or she will probably see an automatic $25,000 loss to the company, even though you may only need $7,500 in chiropractic care. This has the potential of putting you in an adversarial relationship with your own insurance company, which could be uncomfortable. However, your insurance company would still be contractually obligated to pay up to your Med Pay limit.

If you do not have health insurance -- or if you have a high-deductible health plan -- you should seriously consider the advantage of buying the maximum amount available. If you do have health insurance, perhaps one of the lower amounts will be sufficient. When it comes to Med Pay, think about this: the law requires that you have enough insurance to protect other people -- doesn't it make sense that you should have enough in order to protect yourself?

Q. How Long Does Med Pay Continue After the Accident?
This depends on the insurance company from whom you have bought Med Pay coverage, but Med Pay always has a limit. Once this limit is reached -- even if you still have Med Pay funds left -- your insurance will stop paying any claims.

Some Med Pay policies pay for care through one year from the date of the accident; others pay through two years. The only way to know for certain is to check with your insurance company.

Q. Are All Insurance Companies' Med Pay Policies the Same?
Good question. The answer is no.   What Are Some Things I Should Be Aware Of?

"Usual and Customary" Fee Limits

One thing we see insurance companies do is limit the amount they will pay for each visit. This is typically done by "discount" car insurance companies who specialize in low-cost policies. Here's how it works:

The insurance company determines that a certain amount of money is a "usual and customary" fee, supposedly for a certain "geographical area". Then, they refuse to pay any doctor more than this amount. However, these "usual and customary" fee limitations vary from company to company, showing that this is really just an internal number which the insurance company makes up and decides to limit your doctor's daily fee to.

That is, if your doctor's fee for each visit is $100, your insurance company decides that they are only going to pay $90. This leaves the remaining $10 for each visit to be paid by -- guess who? -- you.

Policy of Requiring Medical Documents to Support the Need for Care

A few companies have a policy which states that they require medical documentation about you from your doctor to justify your need to receive care, even though you have received trauma in an auto accident.

This policy requires medical documentation for each and every bill your doctor sends on your behalf. This means that before your doctor can bill your insurance company, he or she must create a report of the treatment for each visit. This delays the sending of your bill to your insurance company; which, of course, means it will take longer for you to receive your Med Pay payment. Also, it means that all this medical documentation about you will be compiled by your auto insurance company.

This policy of requiring medical documents is not universal; many auto insurance companies do not require it. Why, then, would other insurers require it, when all it does is delay payment?

There are two other tricks which insurance companies use to limit their financial obligation to you: Excess Med Pay and Reimbursable Med Pay. These are discussed in the next two sections.

Q. What is Excess Med Pay?
Excess Med Pay is another way of saying that your Med Pay coverage is secondary coverage to any health insurance you may have. This means that if you are hurt in an accident, your health insurance will cover you up to its limits. Once your health insurance limits are met, your medical payments coverage will cover you up to the limits written in your car insurance policy.

Put another way, your car insurance carrier will only provide payments for medical bills which your health insurance carrier did not cover. For example, you incurred a medical bill of $1,000 for chiropractic care following an accident. The bill was submitted to your health insurance for payment. Your health insurance paid $200 for the bill. You now have a balance of $800 owing to your chiropractor. This $800 represents the amount which was in “excess” of what your health insurance paid. As such, your Med Pay will cover this balance and you will spend nothing out of pocket.

The Down Side to Excess Med Pay

1. Excess Med Pay only pays if you can prove that you have no health insurance or other coverage to pay your bills; or that your health insurance has paid up to its limit. Your doctor must prove this every time he or she sends in a bill. It takes at least 30-45 days to send the bill to your health insurance, wait to have it paid or rejected, and then send it to your Med Pay company, who then has another 30-45 days to process their claim. There are always complications and delays.

2. Once your doctor declares you to be recovered from your auto injury, you may well want to seek treatment for something not related to your auto injury. But when you submit the claim to your health insurance -- guess what! you will have exceeded all your health insurance limits from the claims for your auto accident!

3. Excess Med Pay is always reimbursable (see next section). Therefore, we advise you to avoid this kind of Med Pay if at all possible.

Q. What is Non-Reimbursable Med Pay, and Why is It the Best Kind?
. The best coverage is called "Non-Reimbursable Med Pay". This kind of coverage pays your medical bills after an auto accident, and you do not have to pay it back to your insurance company when you get money from the at-fault driver's insurance. Otherwise, if you have Reimbursable Med Pay, once you receive your settlement from the at-fault driver's insurance, you have to pay back to your insurance company what they paid to your doctor in Med Pay payments. This could drastically cut the amount you are able to keep from your settlement amount.

Not all auto insurance companies offer such Non-Reimbursable Med Pay coverage automatically. For many, you must specifically ask for "Non-Reimbursable Med Pay". Therefore, when shopping around, remember to ask specifically for Non-Reimbursable Med Pay. Or, if you have Med Pay already, call and ask if it is reimbursable; if it is, ask to change your policy to Non-Reimbursable Med Pay.

If I'm in an Accident and My Med Pay is Reimbursable, Should I Use It Anyway?

Yes. This will ensure that your doctor will get paid right away for your treatment, which will allow both you and your doctor to focus on your recovery rather than your bill. Also, while you do have to pay back your Med Pay from your settlement, you are able to negotiate the exact amount paid back, thereby saving a little more money for your future physical and financial recovery from your accident. Therefore, using your Med Pay coverage (whether Reimbursable or Non-Reimbursable) increases what you will ultimately be able to recover in settlement.

Non-Reimbursable Med Pay is clearly the best kind of medical coverage available on your car insurance. But like Med Pay itself, it will only help you if it was already in effect before the accident. It is the coverage you purchased before the accident which benefits you as you get treatment, not the coverage you buy after the fact. Fortunately, the difference in cost between Reimbursable and Non-Reimbursable Med Pay is very small.

Q. If I'm in an Accident and I File a Med Pay Claim, Will It Make My Insurance Rates Go Up?
No. Your insurance rates should not be raised simply for filing a Med Pay claim. However, if you are deemed to be at fault for causing the accident, your insurance rates may go up whether you file a Med Pay claim or not.

In any event, if you have been paying for Med Pay for all these years for protection in case of a car accident, it doesn't make any sense not to use it when you need it.

Q. I Was Not at Fault for the Accident -- Why Should I Have to Bill My Med Pay or Pay Out of Pocket?
This is a question we are asked frequently, and we understand why. To many, it seems unfair. Why should I (or my insurance on my behalf) have to pay if I'm not at fault?

But the truth is, you are not paying based on whether you are, or are not, at fault. You are paying because you are receiving health care. And -- as excited and proud as we are to provide the highest quality chiropractic care -- there are costs associated with providing this care which cannot be ignored. Therefore, we ask that when you come in for your first visit after your accident that you please provide your Med Pay information so that we may bill it. This will allow both you and your doctor to focus on your health and recovery rather than your bill.

Q. If I'm in an Accident and I Don't Have Med Pay, Can I Still Receive Treatment at Adams Chiropractic Offices?
Yes! Our mission at Adams Chiropractic is to make the highest quality of chiropractic care accessible to as wide and diverse a group of people as possible. Therefore, we are happy to provide care to patients who do not have Med Pay.

If you do not have Med Pay, then, you will be given the exact same level of care as a patient who does have Med Pay. At the same time, we will ask that you do two things that ensure the proper handling of your case:

1, We ask that you sign a Doctor's Lien. This document will legally obligate your attorney (if you retain one) to pay our office out of the proceeds of your settlement.

2. We ask that you set up a payment plan with our office. This payment plan will allow you to receive care and allow our office to recoup some of our costs. You will continue to make payments according to the agreement until you receive your settlement amount. At that time, if you still have a balance, it is expected that you pay it in one lump sum out of your settlement within 7 days of receipt of settlement funds.

Again, Adams Chiropractic will be pleased to render aid regardless of whether one has Med Pay or not. However, we feel that your experience after your accident will be much less stressful if you do have Med Pay.

Q. After I Have Read This, What Should I Do?
1. Check your policy to see if you have Med Pay.
2. If you don't have Med Pay, seriously consider adding it to your policy. We recommend this action be taken before an accident occurs. You cannot add Med Pay coverage and use it retroactively after an accident.
3. If you do have Med Pay, take a second look at how much you have. If necessary, increase your Med Pay to an appropriate amount.

If you have been involved in an auto accident or a slip and fall and would like more information about insurance and treatment at Adams Chiropractic, please call Jill Sullivan, Office Manager, at (707) 996-0254, ext. 17 or Anthony Gordon, Billing Department Supervisor, at (707) 996-0254, ext. 19.

Other helpful links about Med Pay: