Legal Question in Personal Injury in California
Medical expenses
Should medical expenses submitted to the party responsible for the accident be the amount first billed by the doctor or often the lesser amount that doctors agree to due to their participation in HMO's or other health plans, ie. negotiated amounts if they are network providers under certain health plans?
4 Answers from Attorneys
Re: Medical expenses
The bills submitted to the responsible party should be the full amount of the bill--the gross amount before any reduction or credit. This is sometimes difficult when dealing with an HMO or PPO. If you are in the Orange County area and have a pending legal claim, I'll be glad to provide a free consultation. Sam Eagle 714-963-5123.
Re: Medical expenses
Typically, medical expenses are submitted at their full value. Adjusters know that they are reduced -- often by health insurance, HMOs, or by the doctors' own good will. A settlement should take into account the reality of the situation. -Robert F. Cohen, Esq.
Re: Medical expenses
Compensation for medical expenses is supposed to make you whole, not to give you a windfall. If your doctor would normally charge $1,000 but instead charges you $700.00 under a health plan discount, it will take $700.00 to make you whole.
If anyone should get the extra $300.00 it is the doctor who earned it and not the patient who is hoping to make a profit off of his/her injury.
Re: Medical expenses
The answer by Mr. Cohen is the best.
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