Quick show of hands- who knows what auto insurance medical payments coverage is and how it functions in a claim?
My insurance colleagues know the answer, but if you’re not in the “biz”, probably not. And even if you’ve been involved in an accident before, you may still not know. So, this post is for you- it’s based on a real-life conversation with a client. Not only do I provide an “easy-to-understand” explanation, I’m offering up valuable information that will make your claim much, much easier to work through.
My client’s story
My client (let’s call him Joe) called my office recently. He was very concerned because he only had $5,000 medical payments on his auto insurance policy.
So I asked him, “Why does that concern you?”
He replied, “If I’m involved in an accident, $5,000 is all I’ve got for my family’s medical bills? That’s not enough.”
Ahhhh….. as is often the case, Joe’s question related to his lack of understanding of what medical payments coverage is and how it works in regards to a claim. And I’m sure Joe isn’t the only one who has the same question…….
So, here’s what I told him about Ohio auto insurance medical payments and how they work in an auto insurance claim (hint- this is where you want to pay attention):
What Ohio auto insurance Medical Payments Coverage Is
Simply put, medical payments will pay medical bills as the result of an auto accident. It will pay the driver’s bills, as well as any occupants in the vehicle at the time of the accident.
Ohio auto insurance Medical Payments coverage can be used regardless of fault
Whether or not the accident is your fault or you get hit by someone else, the coverage will step in. I use the term “goodwill” insurance a lot, because it’s simply there to be used as necessary. No admission of fault, no lengthy interrogation, it’s simply there to help you out.
Ohio auto insurance Medical Payments coverage is NOT, nor was was ever designed to replace other methods to pay medical bills
This was really the crux of Joe’s concern- he was worried that NO WAY would $5,000 be enough to pay medical bills should there be a serious enough accident. Hell, even if you have a minor accident, the hospital visit alone will eat up that $5,000 in about 30 minutes.
So I asked him, “Do you have health insurance?” He replied Yes. I then explained that once the medical payments coverage was exhausted, his health insurance would step in and pay the balance.
He asked, “Why doesn’t it work in reverse, health insurance first, then medical payments?”
GREAT question. And the answer is- because the law says so. If there is other valid and collectible insurance to pay injuries sustained as the result of an automobile accident, that must pay first. And it also makes intuitive sense- the root cause of the injury was automobile-related, not an ongoing medical condition or treatment for said condition.
I should also mention that this works the same if he had been on Medicare, Medicaid or had some other health insurance. They all require the medical payments coverage pay first before they step in.
Typical claims process for Ohio auto insurance medical payments coverage:
- Joe runs a red light and hits another vehicle.
- Joe (and applicable occupants) are transported to the local ER for X-rays and other diagnostic tests.
- Joe turns in the claim and the medical payments claim is opened.
- Joe starts receiving the bills from the hospital for the services received.
- Joe submits the bills to the claims adjuster to be paid up to the maximum amount on the policy.
- Once the maximum is paid, the insurance company will send notification that the amount has been exhausted.
EXTRA HELPFUL INFO ALERT #1- a claim will most likely be submitted to the health insurance for your hospital visit. The claim will state injuries were as the result of an auto accident. When you get the Explanation of Benefits basically stating they won’t pay anything for your claim until you provide information about the accident, give them what they’re requesting. They’re asking because of the law mentioned above. So, give them what they need. Otherwise, your claim will turn into one big pain in the ass.
EXTRA HELPFUL INFO ALERT #2- Besides just providing the information requested, you will also need to submit documentation that the medical payments coverage has been used up. It’s usually a letter, but it could be an email, fax, etc. Give them a copy. Then they can begin paying. And you can prevent any hassle.
At my shop, Alan Galvez Insurance, educating clients about and through the claims process is one of our core missions. If we’re in your corner, I guarantee we’ll walk you through just like I’ve outlined above, in order to make your claim and life easier. You can read about our approach to claims and how it helps YOU. Video testimonials are also available.