Should the insurance company cover my medical expenses?

Navigating head around steering column?

 

First of all, I'll just remind everyone that this is what I do for a living.

Second, Lindy, what happens in England has absolutely no bearing on what happens in the US. It's not apples and oranges; it's apples and dipolyethelene. While it would be possible to buy a racing policy in the US, it wouldn't be possible to buy a special event policy simply becaue of the way that Auto coverage is written. In almost all cases it "follows the car". Since a special event policy, by necessity covers the group of racers, it would be illegal in most states to group a bunch of owners/racers since they wouldn't have the necessary insurability. There would be conflicts between the insureds, and potentially two insureds trying to collect under the same policy by suing one another. That's a conflict of interest. The laws must be different in the UK.

Second, this has absolutely nothing to do with health insurance other than chelle doesn't have any. This is the health system in the US as it exists today. Nothing more, nothing less.

Third, anyone who thinks this is a "scam" has never filed any sort of liability claim. This is how it works. It's universale. You sign to waiver saying that you waive your right to sue in return for the payoff. If you think the offer is too low, you can reject it and take your chances in court. Again, that's how the system works. Every company that offers liability (third party) coverage does this. Every. Single. One. Think of an insurance company, and they do this. It is how they settle claims. They may negotiate the amount upwards before they pay the claim, but they don't have to.

As far as the event goes, it's doubtful they had any insurance coverage and that it would apply to Chelle.

 

I'm not the one who is confused, I just worded that wrong. It should be: Based on what primary carrier one has and then its secondary for Chiropractics (if there is one), a co-pay is established. This is if one's primary carrier does not cover Chiropractics. And from what I understand from my own chiro, not every chiropractor has this option.
Certain clinics are the only places that bill you based on ability to pay and get the rest of their funds to operate from donations and/or government stipends and grants, far as I know. Sorry for the confusion.

 

Lindy: any organized event will have you sign a waiver absolving them of damages to property or persons, which means she is out of luck any way you slice it. Again, lesson learned

 

That is the 'American' way. You sign your life away at every turn to prevent others from getting sued. And what are the chances that some normal person would even know what liability insurance is or what is a fair amount, or what they will realize once they aren't dazed and confused? No wonder industry doesn't want this Consumer Protection Agency.

 

No it doesn't. You might think it does, and the event holder would like you to think that, but in many venues, it does not. In Oregon, for instance, a parent can not waive a child's right to sue if they are injured and the child can't waive that right either since they aren't of age. Yet waivers are still needed in Oregon.

You're right - it is the American way. But claiming most normal people don't know what liability insurance is - and just that - is disengenuous. We all know what it is. We may not understand exactly how it works, but we're all aware of it.

As far as a fair amount, you're right, we don't know. But I'm an "insider" and I don't know what that means.

Finally, the CPA has shit to do with liability insurance. They're slightly related in that the CPA might make some product liability rates go up or down depending on their effectiveness at oversight, but that's about it. At the end of the day, the CPA isn't going to dent the usual high risk consumer items, which are children's toy/furniture, lawn equipment and inflatables (bounce houses). Those are the things that cause massive injuries/losses, and all of them are already highly regulated with effective oversight.
--- merged: Jan 13, 2012 12:09 PM ---

This makes even less sense. If I understand it, someone would need to have two health insurance policies. At the end of the day, it's still the consumer buying health insurance and doesn't have anything to do with co-pays other than the policy that covers the chiropractor. Unless I'm missing your point again. It doesn't have anything to do with the doctor's insurance, which is what you said the first time around. Now it's the patient's coverage. So, yeah, I'm pretty sure that I've missed something very big here.

 

It's called actually reading a contract before you sign. Insurance is often demonized, yet the demonizers cry the loudest if there is property or personal damage. A person is free to pursue other options if they don't like a contract. So the big lesson here is to read all terms and conditions and research all options before signing a legally binding contract. It's rather simple really.


the_jazz I understand what you're saying, but in this case I don't see how a waiver could be undone when a person enters an event that has serious risks of their own choosing. Unless you could prove gross negligence I just don't see it. She has already signed a waiver agreeing to payment and having it ammended would cost more than the new terms since there was no serious injury. If she did.pursue this angle it would be a tough and costly method of action.

 

Glory's Sun, while you may think that a waiver is an absolute, experience has told me that it's often not worth the paper it's printed on. In this case, it's almost certainly solid - unless there's a new injury that's revealed itself and was a direct result of the car accident. I don't think that's the case, but maybe I'm wrong. I agree that in this case, the waiver isn't going to be undone - chelle's injuries aren't serious enough and she's already been treated fairly by the insurance company.

"Oh but she wasn't treated fairly, Jazz!" you say? Maybe in hindsight, that seems to be the case, but at the time she signed the waiver, chelle felt ok. She said in her OP that the shoulder pain didn't start until later.

Here's the other thing: this payment is almost certainly coming from the "medical payments" coverage. Despite the implication of it's name, it's designed to provide medical payments coverage for someone injured in an accident - up to $5,000 - regardless of liability. In my world we call that "go away coverage", primarily because it's meant to make the claimant go away and not file a larger claim. In some states, it's not legal to use medical payments coverage to get a claimant to waive the right to file under the liability section. That doesn't seem to be the case here (based on the story as I understand it), but maybe there is some recourse here. It would require getting a lawyer and filing a claim. Her boyfriend's insurance company would then get their lawyers to respond and the fight would be on. As her insurance company, they have a duty to defend him, and they'll use whatever they can to show that her claim should be dismissed. Unless, of course, she's in one of those marvelous venues where lawyers aren't allowed in small claims court (like California, I think), in which case she might stand a slightly higher chance of collecting - but even then it's still not assured.

 

What other opions did she have? You either sign or have to waste hours putting together a small claims court case.

I don't want to be a lawyer.

I already have to be a doctor, retirement planner, investor, tax attorney, etc... because getting a 'professional' who likes doing those things won't be cheap.

 

Do you know why blondes prefer tilt steering?

More head room. :rimshot:

And now we return to our regularly scheduled programming.

 

She had two options - sign or not. If she signed, she knew that was the end of it. If she didn't, then she could have countered their offer. They may not have taken it, but she could have countered.

And there's no way to really know if this is a small claims court case. If she'd hired a lawyer, it immediately wouldn't have been. That's the way it works.

When you're injured by someone else and an insurance company offers you a settlement on their behalf, you're under no obligation to take it. There are times where it may be best for you to file suit - if you know the details of the McDonald's coffee case, you'll see what I mean.

 

Sigh...
No, one does not need two policies. In my case, the Chiropractor took care of everything and got his sessions covered by an outside source. Ask a Chiro how things get covered. I'm just saying how mine worked it out so I could keep paying a co-pay.

 

Just because you hire an attorney doesn't mean it goes to court. Like the_jazz said, she could have countered an offer & then talked to a legal advisor if they didn't accept. She had a myriad of options but chose the quick and easy one, which turned out to not be so easy in the end, however, I think she's still ok & in the best situation she could hope for given her lack of insurance & minor injury.

 

OK, now I think I understand. You're operating under the idea that the missing fees were somehow paid by an insurance company. I know that's impossible, but it is possible that it could be another (non-insurance) source. You just mistakenly assigned that payment to an insurance company. Mystery solved.

 

I must not be speaking English...
The sessions are covered by insurance. Some insurance companies might cover Chiropractics directly, but others, for lack of an industry-specific description you would get, have "supplemental" or outsourced Chiropractic coverage. My Chiropractor has been around long enough to know what Alternative services coverage goes to what primary. While I'm sure there are other ways to have sessions covered (Think CareCredit-a GE Money Bank credit card for health services), in my case, that is not the deal.

 

No, you're speaking English. You just don't know what you're talking about in a conversation with someone who does. I've understood you throughout, it's just that you keep changing what you're saying and trying to use some specific terms to mean things different than what they mean to someone who does this for a living.

But now I think I understand what you mean. But going back to when you first mentioned it, your point isn't relevant since chelle doesn't have health coverage. She would have to have that in order to get the sessions paid for. Chiropractors do NOT have their own insurance companies pay the difference for patients who can't afford to pay (which is what you said at the outset); they find a way to get the patients' health coverage to pay, or they accept a reduced fee. Some, if they want to continue to see the patient, will help that patient find supplemental coverage (in other words a second policy) that does cover the services. You initially confused the patient's coverage with the doctor's coverage, which is why this whole sidetrack developed.

 

Huh - I spent a significant amount of time talking to the part of Hanover that I deal with - an outfit called AIX. They're currently being pains in my ass over something silly. And I had a couple of beers with a guy from Hanover last night who had some very interesting things to say about the book of frame apartment business they've written over the past few years. Something silly about a 120+% loss ratio (that's bad, FYI).

This is exactly what a therapist would do - either they find a way to bill the patient's health insurance company or accept a lower fee. But that's not what ngdawg said up front. She said that the doctors had special insurance coverage to pick up the difference. That sort of thing doesn't exist, at least for doctors (it does on a much, much larger scale for big corporations, though). It boils down to the patient's health insurance, which, again, chelle doesn't have. She can't buy supplemental insurance if there's no primary insurance in place. Any supplemental would, by definition, become the primary. So the claim that doctors have their own insurance to make up the shortfall has, I think, now been complete debunked. There's no falling back on the doctor - it's up to the patient to figure out how to pay for things or to ask for a lower charge.

 

I am so glad healthcare is free here, with the amount of time I've spent in hospitals over the years.