Can anyone help me? I had a lot of doctor bills from an auto accident. About $80,000 worth. Then, about $70,000 from cancer treatment. A very bad year. On the accident, the doctors billed my HMO because the guy who caused the accident initially denied liability. Now that he admits liability, they are willing to settle. My HMO policy says I have to reimburse them for any expenses they paid on my behalf that are reimbursed to me by the wrongdoer. I know that doctors and hospitals negotiate reduced fees with HMO's. I have seen about $80,000 in bills, but have never seen what the HMO actually paid. Is the amount billed by the doctors and hospitals what they normally charge or is it what they will get paid by the HMO (that is, the amount they negotiated for?). This is important, because if I actually owe $80,000 I will want a bigger settlement than if I owe something more like $40,000. If any of you have dealt with a similar problem, I would appreciate your help. Or, is it possible any of you work for a doctor or HMO? Shame on you if you work for an HMO.
I don't know if this will help you, but I was hospitalized in 1991 after a serious accident that was not my fault. My HMO paid for everything. The other driver's insurance company settled for $30,000 (which was the limit of their liability policy). The following month I got a letter from my HMO telling me that if there was any settlement, they wanted to be reimbursed. I threw the letter away and nothing ever came of it.
Great idea. But they made me sign an agreement before paying anything. I am afraid that if I collect the settlement, spend it and then the HMO asks for their money, I am totally screwed. I have been out of work for so long that there are a lot of bills that need to be paid. So, the money will go quick.
I'm new to this board but everyone is so helpful. I have a similar problem but no answer. Is there anyone who can help up? Please!!!
I am going through this very thing right now. I have a PPO and have been receiving statements from the insurance company as to what they paid so far. My concern being how accurate is this info, does the insurance company taking into consideration expenses they paid that are not related to the accident, am I missing any statements? I have other medical issues not related to the accident so of course I do not want those to be included. I too, want to make sure that my settlement will reimburse me for the expenses I have paid (co-pays) as well as reimbursement to the PPO. Don't forget the attorney fees. What I would suggest and I will be doing myself this afternoon is to contact your attorney and ask them if they request this information from your health insurance carrier to factor into your settlement before you settle. When I went through this once before in 1990, the attorney provided a detailed disbursement summary of who got what before I ever saw a check. In fact, the attorney took care of disbursing the funds so what I ended up with was actually mine to keep. Once again, I am going to check out how this all works with my attorney today. I will post if I receive any information. Also, I would definitely make sure the health insurance company gets reimbursed. From what my attorney tells me things have changed a lot since 1990 and they will go after you if you do not reimburse them.
I have a call in to my attorney now on this issue. I was hoping someone would have the answer because it may be a while before I hear from him
Someone out there must work for a doctor or HMO. I thought I would bump this to the top so some of those who contribute in the evening can comment. I agree that this is a matter of general interest. Somebody must have an answer. I also agreee that if you work for a HMO, shame on you.
I'M REALLY GLAD I HAVE "REAL" INSURANCE...NO HMO. MY MOTHER WAITED THREE YEARS IN PAIN FOR THE HMO TO DECIDE TO PAY FOR KNEE REPLACEMENT SURGERY. SHE COULD BARELY WALK.
An HMO would let you die before they decided to pay or approve health care services. Been there, won't do it again!
A farmer I once knew who was pretty much a hermit laid on a stretcher and died because the hospital refused to tend to him due to the fact that it was thought he was a neer do well. The local banker bought the land and had the two buildings on the property demolished, That's when they found more than $180,000 in fruit jars buried under the chicken house floor and even more inside the house itself.
