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Georgia Supreme Court Delivers A Helpful Opinion For Injured Active Military

In the last several years it has become en vogue for hospitals in car wreck cases to try to bypass an injured person’s health insurance and try to get the bill paid from an injured person’s proceeds from their personal injury verdict or settlement.  This may not seem like a big deal at first blush, but practically speaking it means injured victims are losing out on thousands of dollars that is rightfully theirs.

This is how the typical scenario plays out, a person who has valid health insurance is injured in a car wreck that was not their fault.  Following the car wreck, the injured person is transported to the emergency room to be treated for their injuries.  What you expect, when you have health insurance, is that the hospital will send the bill to the health insurance company to be paid.  This is not what is happening.  Instead, the hospital files a “hospital lien” against the injured person’s personal injury claim for the amount of the hospital bill.  The reason the hospital is doing this is because the hospital could potentially make more money this way.  For example, a hospital may only get paid $300 from a health insurance company for a bill (due to negotiated rates), but if that same bill is converted into a “hospital lien” the hospital could potentially get paid the full $1,000 from the wreck victim.

The Georgia Supreme Court in MCG Health Inc. v. Owners Insurance said this practice is not permitted.  In MCG Health the injured car wreck victim was an active duty member of the Army.  The injured serviceman racked up an $18,259.61 medical bill.  Instead of sending this bill to TRICARE (the health insurance for military members) the hospital filed a “hospital lien”.  The injured serviceman then settled his personal injury lawsuit for $50,000.  At the time of settlement, the hospital swooped in and demanded its $18,259.61.  The lawyer for the serviceman said this was unfair and did not release the funds.  Had the hospital submitted the bill to TRICARE at the outset, the amount of money paid to the hospital would have been significantly smaller.  The Georgia Supreme Court agreed that the hospital could not side step the injured serviceman’s health insurance, stating that allowing a hospital to do this would ”defeat the purpose of these agreements which is for TRICARE beneficiaries to have their healthcare costs paid in full at the negotiated rates without fear of further recourse.”

While the MCG case is specifically about TRICARE reimbursement, it is my hope that this case will help stop this unfair practice of hospitals not submitting bills to health insurance companies.

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Posted in: Automobile Wrecks