medical calculation
When adjusters add the total medical expenses for settlement, do they take the provider's billed amount, or the amount allowed by the health insurance company for the $ amount of the medical expenses?
Asked on 6/27/07, 11:39 am
1 Answer from Attorneys
Re: medical calculation
Adjusters look at the actual out-of-pocket number of the claimant, whether it is an unpaid bill or anything that an insurance company paid that it has the right to re-claim. Adjusters take the lower of those numbers or the "Act VI" number, and base their decision on that. (Act VI is short-hand for a Pennsylvania law that puts particular dollar amounts on specific medical procedures.) Although it is straightforward in theory, the mechanics of calculating economic damages can be complex.
Answered on 6/27/07, 11:45 am
