Payment of Medical Expenses Following Albuquerque Car Accident

Do you need medical care after your New Mexico car, truck, motorcycle, bicycle or pedestrian accident or collision? Do you have unpaid medical bills and expenses?  Have no health insurance but need to see a doctor for your injury?

By:  Mark Caruso, Personal Injury and Wrongful Death Attorney (Albuquerque, NM)

You've been in a wreck. You're injured. You need medical care. The doctor's office says they won't accept your health insurance, and the auto insurance company for the at-fault driver won't pay your medical bills (or maybe they won't even return your calls). What do you do?

Auto liability insurance does not work like health insurance. They are not going to pay your medical bills as you go along. The auto insurance company expects you to go out and get all the medical care you need. Then, when you've completed all of your medical care, they want you to gather your medical bills and ask for reimbursement in one lump sum. That's right. You only get one bite at the apple. It's a one time settlement payment. And you cannot go back later and ask for additional money if your injuries turn out to be worse than you thought.

Getting medical care after a car wreck can be complicated and frustrating. A common mistake is failing to contact an experienced injury lawyers like Caruso Law Offices as soon as possible. That error may result in a "gap" in medical care, which the auto liability insurance company will use to argue that you did not go to the doctor because you were not really injured. The insurance company knows it's not true, but they don't care about that. Their goal is to pay you the least amount of money possible. It is extremely important that you get the medical care you need as quickly as possible after the wreck.

You may have been transported to the hospital by ambulance. Or you may have gone to the Emergency Room on your own. Maybe you haven’t been able to see any health care provider because of your concern about who will pay. You will be billed for the treatment you received--whether you have insurance or not. But what do you do after that? At Caruso Law Offices we can help you get the medical care you need, and we can make the at fault driver’s insurance pay for it. Here are some options that you should consider.

• Health Insurance: If you have health insurance coverage, you should use it. Unfortunately, several of Albuquerque’s HMO plans (Presbyterian, Lovelace and Blue Cross/Blue Shield of NM) are now refusing to pay for medical care following a car wreck. Most plans will still pay for the ambulance and the emergency room, but follow up care is usually restricted. Some health plans just push prescription drugs rather than physical therapy and other treatment. You'll still be responsible for deductibles and co-pays associated with your plan, but it sure beats having to pay the whole amount out of pocket! Remember, all plans require you to reimburse them from any settlement proceeds. However, I can usually negotiate a significant discount when your case is resolved.

•Letters of Protection: You'll need a lawyer for this. A Letter of Protection ("LOP") is an agreement made with the doctor's office by your lawyer and you promising to pay the bill from the settlement proceeds. Doctors are not required to accept LOPs, but many doctors will do so. Meet with me to get my list of most local medical doctors, osteopathic doctors, dentists, psychologists, chiropractors, accupunturists, physical therapists, medical massage therapists, MRI’s and others who accept LOP’s. This means that you won’t pay any money out of your pocket at each visit, and you won’t get any bills until we get a settlement. These doctors agree to wait to get paid from the settlement and don’t charge any interest while waiting to get paid.

Because I have been in business for 30 years (25 years in Albuquerque) I have established great relationships with some of the best doctors in Albuquerque. Some medical doctors in Albuquerque refuse to accept a LOP from any other law firm except our firm and one or two others. I will help you find the best health care provider in the best location for you. I also know which doctors you should avoid because of bad reputations with insurance companies. I can usually get you in to see a doctor the day after I begin working on your claim. There is no reason why you shouldn’t find a health care provider to treat your injuries, and there is no reason why you shouldn’t get the best medical care possible. After all, you did not cause the wreck, and the at-fault driver’s insurance should pay for your medical care. I can get you the medical care you need following your wreck.

•Med Pay: You may have Medical Payments Coverage ("Med Pay") on your own auto insurance policy. This coverage typically provides benefits of $2,000 Med Pay can be assigned to medical providers so the doctor's office can bill your own auto insurance company up to the amount of your coverage limit. You should consult me before using Med Pay because there may be strategic reasons to use the coverage for some bills but not for others. Remember, your Med Pay plan requires you to reimburse your own insurance company from any settlement proceeds. However, I can usually negotiate a significant discount when your case is resolved.

•Medicaid & Other Government Benefits: If you already receive Medicaid, Medicare or other government benefits before your wreck, then you should be able to use that coverage for your injuries. It is also possible you may qualify for government benefits after the wreck. In that case, Medicaid may actually go back and pay all of your medical bills from the date of the wreck. Keep in mind, all government benefits require repayment when you recover money in your case. However, I can usually negotiate a significant discount when your case is resolved.

•Pay As You Go: This is the option of last resort if you don’t have insurance coverage available and you don’t want to issue a LOP.

• • • •

I hope this summary really helps you understand how you can get immediate medical care following your accident. I would love to give you an hour of my time to personally meet with you to discuss your specific car wreck and the medical care we can help you get for your injuries. Please call me at (505) 883-5000 at our Northeast Heights Office or at (505) 369-1361 at our Westside Office for a personal appointment with me, not a paralegal. The consultation with me is free, and you are under no obligation to retain me to be your attorney.

Before I began helping people like you, I represented insurance companies. I know how insurance companies operate. Now I only represent victims of car wrecks. I promise to use my experience as a former insurance company attorney to get you the most money possible. To do so you and I must cross every “t” and dot every “i” in order to anticipate and out-smart the tactics and strategies of the insurance company claims adjuster. Remember, their job is to pay you the least money possible, and they will use these tactics and strategies against you unless we are confront them up front.

When we meet I will explain to you that we are only paid if we recover an injury settlement for you. If we don’t get you any money, then we don’t deserve any fees. We don’t charge any attorney fee to get you the highest settlement for your property damage and rental car/loss of use and depreciation/diminution in value of your vehicle. I will also offer you our reduced attorney fee of 29% if we can settle your case without a lawsuit. That means that you put more money in your pocket, and our firm gets less money. We can do this because we don’t spend thousands of dollars on television, billboards and yellow page advertisements.

Please call me today at (505) 883-5000 at our Northeast Heights Office or at (505) 369-1361 at our Westside Office to immediately meet with me to discuss you car wreck. You’ll get honest answers based on my 30 years doing personal injury claims. You’ll also get a discounted 29% attorney fee. I look forward to our personal and confidential meeting. Please call me today so that you do not have a gap in your medical treatment.

Medical Expenses Paid by NM Auto Insurance Company After My Albuquerque Accident Claim



Mark J. Caruso, Personal Injury Attorney

     So often I am asked this question..."What medical expenses can I get from the insurance company now that we know the collision wasn't my fault?"  This is really an easy question to answer, because state law dictates what you are entitled to.  However, just because you might be claiming a medical expense doesn't mean that you automatically get the money for those medical expenses.  It is still up to you and your attorney to provide the insurance company with the facts and evidence to prove the damage.

     Under the law of the state of New Mexico and most other states, medical expenses must be reasonable, necessary and a direct result of the injuries sustained in the collision. 

     The medical expenses must be reasonable in price compared to charges made by othere health care providers in the same community.  This can be easily proven, and our firm has the annually published medical fees to help prove the reasonableness of the charges. 

    The medical expenses must be necessary and needed because of the injury from the collision. No one would expect the insurance company to pay for a medical expense that you really didn't need.  You are, however, required to mitigate your damage.  That means that you are allowed to have diagnostic tests and examinations to determine whether you have an injury.  If you have some pain that you didn't have before the collision, you are expected to take reasonable precaution to determine if you have an injury.  If you ultimately determine that you don't have any injury, the insurance company will still pay for the cost of the examination and diagnostic x-rays and other tests. 

     The medical expenses must be a direct result of the injuries sustained in the collision.  You can't ask the insurance company to pay for anything that their driver didn't cause.  However, they must also pay for the aggravation of a previous injury. As an example, let's say that your leg already had degenerative problems because of your age.  It really didn't cause you any problems before the accident, but the twisting of the leg in the accident required you to now have physical therapy and ultimately a surgery.  You aggravated the degenerative condition so now you must have the extra medical care.  This would be a valid claim against the insurance company.  The medical records provided by your doctor should clearly indicate that the medical care was needed as a result of the collision.  If it doesn't state this on the records, then you should contact your doctor or his/her staff immediately to determine what he/she believes was the cause of the injury in the first place. 

     Once you have finished all of your treatment, it is realitively easy to determine your total medical expenses.  You need to use the retail price of the medical expenses, not the amount paid by your health insurance or the amount you paid as a deductible or co-pay.  It is usually a simple addition of the charges.

     Sometimes doctors will state that you need to get extra money from the insurance company for future medical expenses.  An example would be a doctor stating that you need one physical therapy visit per month for a total of 12 more months.  You would need to calculate the cost of  each visit and multiply times the number of visits the doctor says that you need and you then have an additional number for future medical care.  Again, the same rules apply to future medical expenses that apply to the past medical expenses.  The future medical expenses must be reasonable, necessary and a direct result of the collision. 

   This discussion above is merely a synopsis of the law.  I would ask that you personally call me, Mark Caruso, for a free consultation at 505-883-5000 if you have any questions.  During this conversation will will discuss what happened in your accident, how you were injured and the medical care that you have received or will be receiving.  It costs you nothing to talk to me, and I would like to help you even if you chose not to have us represent you.

  If you mention this blog we will also give you a discount on your attorney fee.  Rather than pay a full 33 1/3% fee that most lawyer charge, we will reduce the fee to 29% if we can settle your claim without a lawsuit being filed.  This puts more money in your pocket.  I hope to hear from you.