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Negotiating Medical Bills After a Settlement

Medical Bill Negotiation After Settlement: A Step-by-Step Guide

Managing medical bills in a personal injury settlement can be difficult, especially after you have reached a settlement. Before settlement, it’s easier to negotiate with the at-fault party in such a way that the settlement amount can cover the medical expenses. But sometimes, medical expenses may rise after settlement due to unexpected health complications or economic inflation. In such cases, being able to settle the bills may depend largely on your ability to negotiate with your healthcare providers, insurance companies, or other relevant parties.

If you need money urgently to pay your medical bills after a settlement, you can apply for post-settlement funding at Stonewood Funding to get the financial help you need. Getting funded quickly by applying online with our easy 3-step application and you’ll get the money as soon as we approve it. We will guide you throughout the process to be sure you’re on the right track. Book a free consultation with us today.

In this blog, you’ll learn about how you can reduce the financial burden of your medical bills by negotiating the right way.

Understanding Your Medical Bills

Understanding Your Medical Bills

In a personal injury settlement, you may find it difficult sometimes to estimate medical bills accurately, especially in cases that involve complex injuries or prolonged treatment. Since medical bills are a major consideration in determining the settlement amount, underestimating the expenses may result in unpaid bills after the settlement. Hence, you need to learn how to calculate and estimate your medical expenses properly so you can negotiate for a settlement that can cover the bills.

Secondly, there are various terminologies and codes in a typical medical bill that you may not be able to interpret without adequate knowledge. Common examples include:

  • Itemized Charges: These are detailed listings of each service provided to you, including tests, procedures, and treatments. Each item will have a separate charge associated with it, and it should correspond to a specific date of service.
  • Coding Errors: Medical billing uses codes to identify specific procedures and diagnoses (e.g., ICD-10 and CPT codes). Errors in these codes can lead to claims being rejected by health insurance companies or incorrect billing amounts.
  • Deductible: This is the amount you are required to pay out-of-pocket before your health or auto insurance coverage starts paying. It resets annually, and its amount can significantly affect your overall expenses.
  • Co-pay: This is a fixed amount you pay for a specific service or prescription, with the rest covered by your insurance.
  • Co-insurance: Unlike a co-pay (a fixed rate), co-insurance is a percentage of the total cost of a service that you must pay after meeting your deductible.
  • Out-of-pocket Maximum: This is the maximum amount you will pay during a policy period (usually one year) for health care services. Once you reach this amount, your insurance will cover 100% of the costs of covered benefits.
  • Explanation of Benefits (EOB): This is a document from your insurance company showing what treatments/services were billed, how much was paid by the insurance, and how much you owe.

Negotiating Medical Bills After Settlement

Negotiating Medical Bills After Settlement

In a personal injury claim, the settlement process involves resolving the case between the injured party or plaintiff and the party or defendant liable for the injury. It often begins when your personal injury attorney examines the case and gathers related evidence, such as medical records, accident reports, etc., to determine the strength of the claim. Your personal injury lawyer then forwards a demand letter to the liable party that describes the damages caused and a proposed settlement amount.

Through a series of negotiations, both parties reach a settlement amount. Your attorney will then submit a written agreement to the defendant or their insurance company. The insurance company reviews, approves, and signs the agreement. Signing the settlement agreement automatically releases the defendant from further liability in the lawsuit, provided they pay the settlement amount.

What Does Your Settlement Agreement Cover?

A settlement agreement details the various terms and conditions that both parties in a personal injury settlement agree to in order to resolve their case. It is a formal and legal document binding on both parties. To be sure you’re within your rights while negotiating medical bills after settlement, make sure you understand what your settlement agreement covers and what it does not.

Typically, a settlement agreement in a personal injury settlement covers how much the defendant agrees to pay, how and when they agree to pay the money, the agreement to release the defendant from any further liability after the payment, and the extent to which the defendant is free from the claims. In most cases, the agreement may also require that both parties keep the terms of the settlement private.

What It Covers

  1. Compensation Amounts:
    • The agreement specifies the total compensation the defendant agrees to pay. This can include damages for medical expenses, lost wages, pain and suffering, and sometimes punitive damages.
  2. Payment Terms:
    • Details on how and when the payments will be made. This can be a lump sum or structured settlement over a period.
  3. Liability Release:
    • Typically, the agreement includes a clause that absolves the defendant of further liability. Once the settlement is paid, the plaintiff agrees not to pursue any further legal action related to the injury.
  4. Confidentiality:
    • Many agreements include confidentiality clauses, requiring the terms and conditions of the settlement to remain private.
  5. Scope of Release:
    • It defines the extent of claims being released, which might include all claims related to the injury or accident, known or unknown at the time of the agreement.

What It Doesn’t Cover

  1. Future Claims:
    • If not explicitly stated, future claims related to unforeseen complications from the injury might not be covered. It’s essential to have clear language about the scope of future claims.
  2. Other Parties:
    • The settlement typically does not cover claims against third parties who might also be liable. For example, in a car accident, one settlement might not cover claims against additional drivers or manufacturers.
  3. Non-Compensatory Damages:
    • Unless specified, items such as emotional distress without physical injury might not be covered, depending on jurisdiction.
  4. Rights of Others:
    • Settlements usually do not affect the rights of others who may have been injured in the same incident unless they are explicitly part of the agreement.

What Kind of Injuries Will Qualify You For Funding?

What Kind of Injuries Will Qualify You For Funding?

Personal injuries that qualify for funding are mostly injuries due to the misconduct and negligence of the at-fault party. Typically, injuries leading to long-term health problems or permanent disability often result in higher settlements due to ongoing medical costs and life care expenses. Examples of such injuries are traumatic brain injuries, spinal cord injuries, broken bones, psychological injuries like PTSD, etc. The more severe the injury, the higher the personal injury settlement amount.

Ultimately, the total cost of medical treatment may vary depending on:

  1. How serious the injury is
  2. The type of medical treatment procedure required
  3. How long the treatment takes
  4. The medical care provider involved
  5. How effectively you negotiate

For minor injuries requiring basic treatments, you may spend a few hundred dollars. For severe injuries that may require surgery, rehabilitation, or other forms of long-term care, the cost can run into tens or hundreds of thousands of dollars. Injuries that take a short time to treat also cost less than those that require continuous treatment over a long period.

What If Your Medical Bills Are More Than Your Settlement?

Negotiating medical bills in a car accident or personal injury case is usually intended to make sure that the settlement money can take care of these bills no matter how much they cost. Generally, your medical bills are paid from your settlement fund. If you paid your medical bills with your own money before the settlement, you can seek a settlement amount enough to reimburse your spending.

If you do not have enough money to settle your medical treatment expenses before your settlement arrives, you can apply for pre-settlement funding. Also known as lawsuit loans, pre-settlement funding provides you with a cash advance to pay your medical expenses and sort out other pressing needs as you wait for your settlement. On the other hand, you can negotiate with your medical provider to set up a medical lien on your settlement. This means the medical provider would have to wait for the settlement before you pay them.

However, there may be cases where your medical bills are more than your settlement amount. In such cases, you may resort to negotiating with your healthcare provider to reduce the bill or set up a payment plan to allow you more time to offset the bills. Additionally, depending on your insurance coverage policy, your insurer may also cover the remaining costs.

Tips for Thoroughly Reviewing Medical Bills for Inaccuracies

It’s important to be as accurate as possible when estimating or reviewing medical expenses during your settlement. If you underestimate your medical bills, you may end up with a settlement amount lower than your medical care costs. Here are some pro tips for reviewing your medical bills to avoid inaccuracies.

  1. Verify Your Information: Always check the patient’s name, date of service, and provider information to ensure they are correct. Errors here can indicate processing mistakes or even fraudulent charges.
  2. Match Charges with Services Received: Compare your itemized bill to the services you remember receiving. Confirm that every listed service was actually provided and is not duplicated.
  3. Check for Coding Accuracy: If possible, ask for the details of the medical codes (ICD-10 and CPT) used on your bill and look them up to see if they match the services you received. Incorrect codes can lead to higher bills or denied claims.
  4. Crosscheck the Amounts: Check the amounts charged for each service. If something seems unusually high, it could be a mistake or an overcharge.
  5. Review Insurance Responses: Compare your medical bill with the Explanation of Benefits (EOB) document from your insurance provider. Ascertain that the insurance payments and your responsibilities match what was initially agreed upon under your insurance terms.
  6. Question Unfamiliar Items: If there are services or items you do not understand, do not hesitate to call the billing department for an explanation. Sometimes, merely questioning a charge can uncover an error.
  7. Keep Good Records: Keep all your medical documents organized, including bills, EOBs, and records of any communication with healthcare providers and insurers.

Strategies for Negotiating Medical Bills

Strategies for Negotiating Medical Bills

As the plaintiff in a personal injury lawsuit, it’s crucial to know various strategies on how to strike deals with your healthcare providers, collection agencies, insurance companies, and any other party involved. These strategies can help reduce your overall medical bills.

First, clearly explain your situation with a friendly and respectful attitude to the billing department. Be polite but assertive. If you’re not sure about an item or a charge in your bill, seek clarification. Having a clear understanding of the charges may help you bargain more effectively.

Secondly, you can offer to pay a portion of the total medical bill as a lump sum payment. That way, some healthcare providers may be encouraged to offer a discount since you’ll be providing immediate payment. Offering to pay a lump sum can also save your provider the administrative cost involved in processing payment plans.

If you can’t afford to pay a lump-sum amount, explain your financial issues to your healthcare provider or insurer. They may propose a payment plan that fits your budget. Make sure the payment plan has terms you can manage, such as a wide payment period or reduced monthly payments.

Furthermore, if your healthcare provider or insurance company offers any hardship programs or financial relief for patients who can’t pay their bills, apply for them. You may get discounts or subsidies from these programs, depending on your income and financial needs. Note that this may require you to provide certain relevant documentation. Also, diligently follow up with your application to ensure it is processed. If you don’t have an insurance plan, ask if your medical care provider gives lower rates to uninsured patients.

Moreover, hire a professional attorney, negotiator, or medical billing advocate to help you negotiate effectively. With their experience in handling medical bills, they can help you lower your payment.

Legal Considerations and Compliance

Legal Considerations and Compliance

If you’re facing medical debt in the United States, there are various laws that are stipulated to make sure that you’re treated fairly by the people you owe. At the federal level, the laws include the Fair Debt Collection Practices Act (FDCPA), and the Affordable Care Act (ACA). Your rights as provided by these laws include:

  1. Right to a clear, accurate billing statement
  2. Right to argue or dispute billing errors
  3. Right to a non-abusive, non-deceptive, and fair debt collection practices
  4. Right to financial assistance
  5. Right to prior information before billing (no surprise billing)
  6. Right to access to health care services without discrimination
  7. Right to file for bankruptcy
  8. Right to privacy and confidentiality.

Need Pre-Settlement Funding?

Negotiating medical bills after settlement is important as it helps minimize the financial burden and maximize your settlement. If you get your medical bill estimation wrong or have a poor negotiation, you might end up settling for an amount that will not be enough to clear your expenses. Hence, it’s best to consult with an experienced personal injury attorney to be sure you understand everything included in your medical expenses. Your attorney can also help you secure more favorable terms when you negotiate with your health insurance company.

If you’re finding it difficult to clear your medical expenses after settlement, Stonewood Funding can give you post-settlement funding as a cash advance to sort your bills while you negotiate medical bills. Even if you’ve not reached a settlement in your personal injury claim, you can apply for our pre-settlement lawsuit loans and pay them back when you secure your settlement money. We’re always available to provide the financial assistance you need. Book a free consultation with us.

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