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Medical Bills: Juries Should See Both Billed Amount and Adjustments?

If you have health insurance, you might have noticed that certain healthcare providers will provide a discount on medical bills based on the type of health insurance you have.  If you have been injured by another person’s negligence, Missouri and Kansas law state that you are entitled to recover the amount of the medical bills that were incurred because of that person’s negligence.

Debate in Personal Injury Suits

Insurance companies have worked very hard to change the law so that a jury would only see that amount of the discounted bill, and not the original amount of the bill. Thus far, they have been unsuccessful. Insurance companies argue that the negligent party should only be responsible for the amount needed to satisfy the bill, not the entire amount.

Thus, there is a debate about whether, in a personal injury suit, juries should be made aware that the amount charged by an injured party’s medical provider might be different than the amount the injured party actually paid or personally owed to that provider after any discounts to the bill were made.

Health Care Provider Discounting Rates

At the root of this issue is the healthcare provider practice of discounting the amount billed to their patients resulting in a discrepancy between what was charged and the payment they ultimately receive.  This is often done because health care providers have contracted with insurance companies to discount their rates for specific practices and procedures.  However, this practice also tends to discount the value of the provider’s services and in turn the value of an injured person’s claim.  This results in lower recoveries by injured people and in turn, penalizes those who have paid and worked for the benefit of health insurance policies and rewards the negligent conduct of the at-fault party.  In other words, the at-fault party receives the benefit of the injured party’s payment of health insurance premiums, which entitled the injured party to those discounts on the bill.

Medicaid and Medicare

Similarly, Medicaid and Medicare have usually negotiated extraordinarily low rates with providers.  Health care providers often state that they are barely breaking even or taking a loss when providing care for Medicaid and Medicare patients as the amounts reimbursed are so small.  This translates to lower personal injury recoveries to the already financially disadvantaged patients who are the typical recipients of government health insurance.  And keep in mind that most Medicare recipients have paid into the Medicare system through their employment and have thus paid for the benefit of receiving Medicare.

Insured Party Penalized

Insured parties have already paid for the privilege of their discounted services through the payment of health insurance premiums and for services to their employer (and in the case of those insured by Medicare, through years of paying taxes), and they should not be penalized for having done so when they are injured and are forced to exchange their health for the payment of money by the negligent party.  The policy advocated by the insurance industry and the chamber of commerce benefits the wrong-doer and not the injured party.

If you have been injured because of someone else’s negligence, call Aaron House at 816-875-4260 for a free consultation to discuss your personal injury case.

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Related Posts: Liens in Your Personal Injury Case: Medical Providers and Health Insurance in Missouri and Kansas

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