Medical Bills – Are You Paying Too Much?

Most people don’t have a clue as to what routine medical care costs, much less surgery, advanced imaging, or hospital care often associated with personal injury cases. We essentially rely on our medical providers to bill us a fair amount for these services, and hope that our insurance covers most of the bills. Of course, even when those bills arrive it is difficult, if not impossible, to tell if we’re being taken to the cleaners. It’s not like there is an easy way to find out the average cost of medical procedures in our area. Or is there?

Medical Costs Explained and Compared – The Health Care Blue Book

There is a wonderful and free online service which can tell you the average cost for a large variety of health care treatments in your area, The Health Care Blue Book. It is geared towards educating those without health insurance, or those with high-deductible plans (and therefore, large out-of-pocket costs) as to how they can get the most bang for their buck at the doctor’s office. But even those with health insurance, especially personal injury claimants, can benefit from the information on this site.

Just to give you an idea as to how specific the site can get, let’s say you want to know how much an MRI of your knee will cost. From the site’s intuitive menu system, you choose Physician, X-Ray, Imaging, MRI. From there you are presented a list of 31 different MRI services. Three of those are for the knee, because they let you choose whether you want to price it (1) with contrast, (2) without contrast or (3) with and without contrast. Clicking on any of these will produce the fair cost for the service. If you enter your zip code into the site, it will factor that into its cost determination. How cool is that?

Settlement tip

The site goes even further than just giving you cost information. For each service it covers, it also gives you tips on where to go or how to save money. For example, on the knee MRI page, it warns that some imaging centers charge three to five times more than others, so you should call around to get the best price. It also gives you a pricing agreement you can take to your health care provider (listing the blue book price) so you can get your provider to agree in writing as to the cost of your procedure. The site also provides general advice on how to negotiate lower prices with your health care providers.

If you require a medical procedure such as an inpatient surgery, which often results in bills from multiple providers (e.g., hospital, physician, anesthesiologist), the site will give you the fair cost for each billing party, conveniently totaled at the bottom. The site even covers mental health treatment, cosmetic surgery, and dental treatment. After your lawsuit is over, are you thinking about getting a boob job (ladies) or laser removal of your back hair (gentlemen) with your personal injury settlement money? This site has you covered for that, too. One notable omission from the site is the cost of chiropractor treatments. Maybe that will be addressed in the future.

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How Medical Costs Affect Your Personal Injury Settlement

So, why should you, as a personal injury plaintiff, care about keeping your medical costs down? You’ve got health insurance, and the defendant’s going to wind up paying your medical bills anyway, right? Well, keep in mind that you will likely have to repay your health insurer from the settlement proceeds. Also, any outstanding medical bills due to deductibles or any other reason will also come out of your settlement. Remember that these costs are paid from your share of the settlement, meaning “after your attorney has already taken out his attorney’s fees.” So every dollar you save yourself in medical or health insurance liens is an extra dollar in your pocket. So why not use this free site to help you haggle with your health care providers? The money you save on medical bills now will be yours when your lawsuit is over.

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13 Responses to Medical Bills – Are You Paying Too Much?

  1. dora ayala says:

    I need advice Dr is charging me for reading an MRI for each boby part that he read 4 @ 200.00 plus 450.00 for visit, is that fair and how can I dispute it. It’s on a LOP

    • fl_litig8r says:

      This may or may not be reasonable depending on the doctor’s specialty and certifications, as well as regional factors (some cities cost more than others). It also depends on whether he is a treating doctor or just an expert witness (experts charge more). If you feel that you are being overcharged, your lawyer can try to negotiate the doctor’s bill down after the case is resolved. Even though the doctor has an LOP, most lawyers will routinely try to negotiate these bills down anyway. It may even be that your doctor is overcharging in anticipation of having his bill reduced at settlement.

  2. NYUnionMan says:

    Hi,
    I was just recently denied authorization for a prescription and ended up paying out of pocket for it. To my surprise the cost was only $90.65. When I got home I when through my papers where I had to invoices from a Healtsystems, L.L.C.. What was strange was the invoice had the provider as Stoneriver Pharmacy Solution for the same mediation and I just purchased over the counter for $90.65. The thing is all my prior prescriptions were filled in the Bronx at a local pharmacy. Why was Stoneriver Pharmacy Solutions stating they were the provider in Memphis, TN? The thing is Stoneriver Pharmacy Solution submitted a bill for $389.48, when on this last prescription I only paid $90.65 cash. If I didn’t know better I would think this is a form of Federal Mail and Wire Fraud.
    How is it I can pay for a prescription over the counter in the same local pharmacy and only pay $90.65, but when authorized by the claim adjuster the prior 6 months the bills show a provider in TN and the cost $389.48. Then the invoice is from Healthsystems in
    Florida mailed to Travelers in N.Y.? Stoneriver’s website states they are affiliated with over 60,000 pharmacies throughout the country, naturally their prices have to be much lower then the $90.65 I paid out of pocket, so where is the justification of them billing for $389.45. Would love to hear any response! Thanks great site!

    • fl_litig8r says:

      Perhaps New York should take a closer look at Stoneriver’s billing practices, as Massachusetts did almost 2 years ago. While I can understand there being a surcharge added to the cost of the prescription for their billing service, charging more than four times the no-insurance, cash price for drugs seems pretty outrageous. Maybe New York’s state attorney general should get a tip about this?

      • NYUnionMan says:

        Wow, what can I say, your really good! I was totally shoocked when opened the link of the Massachusetts case were kind enough to post. I couldn’t believe it involved StoneRiver Pharmacy Solutions and then to find out this was the eighth settlement of this kind with StoneRiver. This clearly shows that it’s clearly much more involved with StoneRiver having over 60,000 pharmacies under contract. The profits appear to be so vast that the company finds it’s worth it to settle a few million dollars settlement instead of changing their practices.
        This is truly sad that criminal charges haven’t been filed and a much larger investigation hasn’t taken place. Well I have contacted a legal firm in Washington, DC who handles Fraud Act Claims and hopefully they will file on my behave. If not I will have to bring the case to the New York Inspector General”s office. Again thank you so much for taking the time to respond and share that very important link about StoneRiver. They are directly affecting all injuried Workers Compensation claimants who have to take these pain medications, hopefully now that this is defrauding the largest state with these kinds of claims something may finally change. Your the BEST!!!!!!!!

  3. robyn says:

    my son is about to settle with insurance company about an accident in which he was not at fault. we consulted a lawyer in the beginning and decided to move forward without an attorney to see if he could get the max without splitting the settlement with attorney. We managed to do that which is fantastic but the next step is negotiating the 500,000.00 hospital bill. I am looking for a sample letter to get me started. he still has surgery in his future and continues to heal but physically his injuries are permanent and as a result his military career has been cut short. thanks robyn

    • fl_litig8r says:

      Although every lien reduction letter will need to be tailored to the particular facts of each case, a decent starting point would be this sample. I’d elaborate a bit more than the sample did on the true value of your son’s case, versus what you accepted in settlement due to [insert reasons here, e.g., inadequate policy limits, risks in proving causation or liability, desperate need for money now to pay for whatever urgent expenses your son may have]. I assume that when you say “the max” you mean that you settled for policy limits, which should help your position in arguing that you took less than full value. So, if your son’s case was worth $1 million and you settled for $500,000, it wouldn’t be unfair for them to share the 50% reduction in the total recovery, reducing their lien by at least that amount. Tug on their heartstrings some by discussing his military service and how disappointed he is that he can no longer serve his country (at least in that capacity), that disappointment only being further compounded by his consequent loss of income.

      If part of these bills were paid for by private (non-military) health insurance, you should read this article, as it will give you ideas for other arguments.

  4. Kimberly Couch says:

    I hope this is the right section for this question! We just settled a personal injury case from an auto accident that happened 12/24/12. We are not happy at all with the way this was handled! I don’t want to go into specifics here, but my question is regarding medical bills. First off, money has been sitting in our Medpay account for quite a while, actually the checks are signed so the money is probably in the attorneys account collecting interest! No bills have been paid yet and we were told the other day after we got a copy of our settlement sheet that they were going to be paid within a couple of weeks. Why a couple of weeks? They supposedly collected the balances quite some time ago. In the meantime, we are starting to get collection agency notices, which I have forwarded to the attorney. I also see that on our settlement sheet, he has noted the full amount charged to be paid. I’m not real stupid, but I also know that the longer the bill is outstanding, the better the chance of negotiating a lower payment to settle account. None of these bills are negotiated though! I am thinking that the reason for waiting a couple of weeks to pay them now is so that he can present us the full bill to be paid, BUT he is NOW going to negotiate them down! I don’t feel that he will turn around and tell us this and refund us money. We didn’t get all of our medical paid as it was, then he took his fee, of course reduced it a little bit, and the rest came out of our offers from the adjuster. Med bills were over $30k, he only got $24k, took a fee off of the $24k so I think you can follow how much we still owed for medical! I have a sneaking suspicion that he is going to make out on the medical still.

    • fl_litig8r says:

      First, interest on client money held in lawyer’s trust account doesn’t go to the lawyer or the client. It goes to the state bar, usually to pay for legal services to the poor. Lawyers have no incentive to needlessly hold money in their trust accounts.

      Second, you’re making a pretty serious assumption that your lawyer is going to commit fraud, which hardly seems worth the risk given the small amount of money at issue and the fact that it would be simple for anyone to prove. It’s something that would very likely result in him getting disbarred, which is why I don’t think any lawyer would be stupid enough to risk it over a few thousand dollars. I think the more likely scenario is that your lawyer showed you a proposed distribution with the full amount of the medicals as a worst case scenario, and that he is indeed going to try to negotiate these bills down on your behalf, with you being the beneficiary of these negotiations. An unresolved lien issue would be the only reason to hold onto money in the trust account. If he was going to pay the full amounts out to the lienholders, there would be no need to wait.

      Instead of assuming the worst from him, why not just ask him directly if he’s delaying the distribution to negotiate the liens down? Why would a lawyer who was nice enough to reduce his fee then turn around and try to defraud the client? It doesn’t make any sense to me.

  5. v says:

    daughter had accident in aug, she was stopped at a red light , there was a car in front of her, she was rear ended and she hit car in front of her, daughter car totaled, she had a friend in her car who was injured too they both have herniated disk and are going to therapy, my question is the at fault driver had a 50.000 policy for BI, the other girl has an attorney , my daughter choose no to have an attorney until insurance make offer, and if not enough then seek attorney, so how do the insurance divide the 50 k, can the other
    girl claim all 50k because she has an attorney and my daughter get nothing? thank you for your help
    i was told also that driver in front car has an attorney too . so if we get an attorney there will not be much left if they all 3 have to split the 50k we really concerned about getting enough to cove all med bills . thank you

  6. maria [last name removed by admin] says:

    Hi, thank you in advance for your help.
    I got in a car accident back in 2013, went had lower back surgery in 2013 and another one march 2015′.

    i went to my lawyer yesterday to sign a settlement for my surprise there were lots bills from my first surgery that wasn’t beeing paid and need do be taken from my money, what I know is correct.

    The problem is i don’t inderstand why these bills werent sent to my private health insurance. Lawyer said that the treatments I receive it at that time wasn’t necessary and Travelers didnt pay them, but why I nevre receive it any bill and they never send to my health insurance, I dont undertand.my lawyer also said there a time limit to send do primary insurance it is from 6 months a 1 year and now are more than 2 years. What should I do in this situation. the bills are more than $80.000. and I need to pay?

    please help me!

    • fl_litig8r says:

      Ultimately, the burden falls on the patient to ensure that all medical bills are paid, which includes ensuring that they are timely submitted to the health insurer. That’s not to say that you should just give up. Try calling your health insurer and explaining the situation. They may agree to process the untimely claim. If they won’t, see if they would process the claim if you paid the bill directly and then sought reimbursement from them (I know it sounds like the same thing, but technicalities sometimes matter). Finally, ask if they have a contract with the provider(s) (are they “in-network” providers) and if so, whether that contract allows them to bill a patient directly if they fail to timely submit a claim. I assume that you informed the providers of both your auto and health insurance, such that they can’t claim that they didn’t know about the health insurance.

      If everything fails, you will be responsible for the bills. Maybe you could negotiate them down.

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