After A Car Accident, Can I Use My Health Insurance To Seek Medical Care?

In California, your health insurance can help pay for accident-related treatment and associated costs. This coverage can give you quick access to doctors and specialists and may minimize your medical bills and potential debt.

In this article, we’ll explain how health insurance works after a car crash and what steps to take for your medical care. We’ll also discuss the limits and potential costs of health insurance, as well as your options if you lack sufficient coverage.

Using Your Health Insurance For Medical Treatment After A Car Accident

You can use your health insurance to pay for medical expenses after a car crash. In most cases, your policy will cover costs for hospital visits, surgery, and rehabilitation.

In California, people often use health insurance when medical bills are high or when related auto policy add-ons, such as MedPay, aren’t enough to cover the full cost of treating their car accident injuries. For instance, MedPay usually pays first, but its limits are low. Once those funds run out, your health insurance can step in to cover the rest.

Without this coverage, you may incur significant medical bills, potentially leading to debt or bankruptcy. For example, a broken leg can cost up to $7,500 to treat, and a three-day hospital stay can reach $30,000 or more.

What Your Health Insurance Typically Covers After A Car Accident

Health insurance usually covers a wide range of accident-related medical expenses. Examples include costs for:

Coverage details, including exclusions, limits, and network restrictions, vary per plan and depending on your state’s insurance rules. It’s important to review your policy to see what it includes.

How Coordination Of Benefits Works

When you have both auto and health insurance, the coordination of benefits (COB) system determines which policy pays first and how much each insurer covers. To clarify the process, here are some key points you need to know about.

Payer Order

In California, the order of payment for medical bills after a car accident generally proceeds as follows:

1. MedPay (Medical Payments Coverage) — If you have MedPay as part of your auto insurance policy, it usually pays first. This optional coverage helps cover accident-related medical expenses, regardless of who’s at fault. These typically include ambulance rides, emergency care, and doctor visits, up to your policy limit.
2. Health Insurance — After you use up your MedPay benefits, your health insurance steps in to cover approved medical expenses. You may still be responsible for any deductibles, co-pays, or coinsurance.
3. At-Fault Driver’s Insurance — Ultimately, the at-fault driver’s liability insurance is responsible for your medical bills and related damages. You or your attorney must file a claim to pursue compensation from the at-fault driver’s insurer. However, the claims process is usually time-consuming, so your MedPay and health insurance may cover costs initially.

Keep in mind that every insurance policy is different. The exact order of payment and what’s covered depends on the details of each plan, as well as the specifics of your car accident.

The Anti-Duplication Rule

Insurance policies have anti-duplication or “no double recovery” clauses. Under these rules, you cannot collect more than the actual cost of your medical bills. If one insurer pays, the other will only cover any remaining eligible expenses. Overlapping payments are not allowed.

Subrogation

If your health insurance covers expenses that are later paid by the at-fault driver’s liability coverage, it may seek reimbursement through subrogation. This process allows it to recover the medical costs it previously paid for, usually from the compensation you receive from a third-party claim.

However, in California, your health insurer is generally limited to recovering no more than one-third of your settlement. Recovery may also be restricted if you haven’t received full compensation for your losses. There may be exceptions, so review your specific policy and consult a professional if needed.

Notification And Documentation

Promptly notify both insurers about the accident. Provide claim numbers, accident reports, and requested documents. Tell your healthcare providers which insurer should be billed first so claims are processed in the correct order.

What Are The Coverage Limits And Potential Costs Of Using Your Health Insurance?

Health insurance policies have maximum limits on how much they will pay each year or over your lifetime. They may not cover all the treatments you receive for your injuries after a car accident. Some policies exclude:

• Preventative chiropractic care
• Specialized medical equipment
• Extended physical therapy

In addition, using health insurance after a car accident usually means you may have some out-of-pocket costs, including:

• Deductibles — The amount you must pay yourself before your health insurance starts to pay. For example, if your deductible is $1,000, you pay the first $1,000 in medical costs.
• Co-Pays — Fixed fees you pay for each medical service. Examples include $40 fees for doctor’s appointments and $100 fees for emergency room visits.
• Coinsurance — The percentage you pay after meeting your deductible. For instance, with 20% coinsurance, you’re responsible for 20% of the bill, and your insurer covers the other 80%.
• Balance Billing — The amount a healthcare provider may charge you for the difference between the cost of their services and what your insurance pays. In California, balance billing for emergency services or care at in-network facilities is generally illegal. However, it’s still something to watch for in other situations.

These costs can add up quickly, especially if your injuries are severe or require ongoing care. If your medical bills go beyond your policy’s coverage limits, you are usually responsible for paying the remaining balance out of pocket.

It’s also important to note that an employer-provided health insurance policy may be an ERISA plan governed by federal law. These often follow different rules compared to state-regulated plans, which may affect your coverage limits, protections, or appeal options. Differences in regulation can also influence how subrogation and other reimbursement claims proceed.

Having said that, it’s essential to review your insurance details and seek legal help if you have questions.

Step-By-Step Guide To Managing Insurance Claims After A Car Accident

Managing health and auto insurance claims after a car crash is crucial for seeking immediate medical care and protecting yourself against significant financial losses.

Here’s a practical guide to help you get the care you need and handle your claims.

Step 1: Seek Medical Attention

Go to urgent care or visit the ER right away, even if you feel fine. Ensure the doctor explicitly notes that you’re specifically receiving treatment for injuries from a car accident. Keep the record they create to show that you needed immediate medical care after the crash. You can also save all other paperwork, bills, and discharge instructions from your visit. Thorough documentation can make it easier for insurers to approve your medical expenses.

Step 2: Notify Your Insurance Companies

Contact your health insurance and auto policy providers as soon as possible, ideally within 24–48 hours. Let them know about the accident and that you received medical care. Ask what documents they need from you.

With this strategy, your health insurance can take care of your main medical bills, while MedPay can be used to reimburse you for any co-pays and deductibles that remain. This method can help you avoid high out-of-pocket costs.

However, some health insurance plans require you to use MedPay first. Check with your insurer about the correct billing order for your situation.

Step 3: Gather And Organize Your Documents

Start collecting important paperwork as soon as possible after the accident. Examples of what you can gather include:

• Medical records and bills.
• Receipts for prescriptions or ambulance rides.
• Accident reports from local law enforcement agencies.
• Any photos or videos from the scene, such as from dashcam or security camera footage.

Keep everything in a folder or digital file. Having your documents organized will make it much easier to file insurance claims or get help from a lawyer if necessary.

Step 4: File Your Claim

Give your doctor your health insurance information when you receive treatment. Medical professionals usually charge your insurer directly. If you pay anything out of pocket, keep the receipts for reimbursement.

Step 5: Maintain Timely Communication

Respond quickly if your insurer needs more information. Check your claim’s status to make sure your bills are processed and paid.

Alternative Options If You Have Insufficient Health Insurance Coverage

If you don’t have enough health insurance or can’t afford out-of-pocket costs, you may have other ways to get the care you need. Here are some of them:

• Medical Payments Coverage (MedPay) — If you haven’t yet, check your own auto policy first. MedPay could cover immediate medical expenses up to your policy limit, but you may still have out-of-pocket costs if bills are higher.
• Uninsured/Underinsured Motorist (UM/UIM) Coverage — If the at-fault driver has no or insufficient insurance, this optional add-on to your auto policy could compensate you for bodily injuries, lost wages, and pain and suffering. Coverage limits apply, so severe injuries may not be fully covered.
• Medical Liens/Letter of Protection — Many doctors (including specialists and surgeons) offer treatment on a lien basis. Under this arrangement, you pay for medical care out of your potential settlement rather than up front. Your attorney provides a Letter of Protection, a legal agreement that ensures the provider is paid directly from any compensation you receive. Not all providers accept liens, and the final bill may be higher.
• Medi-Cal — If you meet income and asset requirements, you can apply for Medi-Cal at any time. It can help pay for unpaid medical bills from up to 1–2 months before you applied. There are strict limits on how much it will reimburse.
• Medical Factoring — For complex cases, a factoring company may purchase your medical debt from the provider. They pay the doctor up front and then wait for reimbursement from your potential settlement. However, fees or interest may be added.
• Sliding Scale Clinics — Some clinics charge fees based on your income. This program makes care more affordable for uninsured or underinsured patients. However, not all services are available, and wait times may be longer.

Figuring out which insurance options apply to your specific situation after a car accident can be confusing. With so many policies, limits, and requirements, it’s easy to feel overwhelmed or unsure where to start. In this scenario, you may think, “I need a personal injury lawyer.” Consider seeking free accident lawyer advice to review your options and receive guidance on the process.

Common Questions About Using Health Insurance After A Car Accident

Many car accident victims worry about whether health insurance can cover their medical care needs. Although the at-fault party’s insurer is primarily responsible for injury-related losses, you can use your healthcare policy while pursuing compensation.

Below are answers to some of the most frequently asked questions about using health insurance after a car accident in California.

What Is A Health Insurance Deductible?

A health insurance deductible is the amount you must pay for medical care before your insurance starts covering costs. For example, if your deductible is $1,000, you pay the first $1,000 of your medical bills yourself. After that, your insurance pays according to your plan.

Does Health Insurance Cover The Entire Bill?

Health insurance may not cover your entire medical bill. If your plan includes coinsurance, you remain responsible for a set percentage of your treatment costs. For example, your insurer might cover 80%, and you pay the remaining 20%. This amount is not a fixed fee, but a share of the total bill each time you get care.

There is also a maximum out-of-pocket (MOOP) limit. This amount is the most you will pay for covered medical expenses in one year. After you reach this limit, your insurance pays the rest.

What Is Not Covered By Health Insurance After A Car Accident?

Health insurance only pays for approved medical care. It does not cover lost wages, pain and suffering, or damage to your car. It usually pays after you use up your auto coverage. Many plans also do not cover care outside an insurer’s network or costs associated with certain alternative treatments. You are still responsible for deductibles and co-pays. You may also need to seek payment from the at-fault driver’s auto insurance for other losses.

Will Using Health Insurance Reduce My Settlement?

Using your health insurance to pay for accident-related medical care does not directly reduce the compensation you may receive. However, your health insurance company may ask for reimbursement from your settlement for the bills they paid. This process is called subrogation.

If your car accident claim resolves with compensation, a portion may go to your health insurer to repay those costs. As a result, the final amount you retain could be lower.

What If My Health Insurer Refuses To Pay Because I Was Injured In A Car Accident?

If your health insurance provider refuses to pay for your medical care because a car accident caused your injuries, request a written explanation as to why it rejected your claim. For example, you may receive a denial due to your insurer’s role as a secondary payer for crash-related injuries. However, if your MedPay benefits have already been used up, you may have valid grounds to argue that your health insurance should step in.

When requesting an explanation, provide your insurer with proof of exhaustion from your auto insurance carrier. Include the following details:

• Claim numbers
• Coverage limits
• Accident report (if requested)

If your health insurer still refuses to pay, you can file an appeal. You may contact California’s Department of Insurance for questions or to submit a complaint. A lawyer can also help you manage the appeals process and advocate for your rights.

Many health insurance policies require that auto insurance pay first for accident-related medical expenses. Review your health insurance policy for any exclusions related to auto accidents and clarify your rights with your insurer.

When Should I Consider A Lawyer For My Health Insurance Claim After A Car Accident?

Consider consulting a lawyer for your health insurance claim if:

• Your injuries are severe or long-lasting.
• You’re confused by policy details or paperwork.
• There’s a dispute about who caused the accident.
• The insurance company argues over which policy should pay for your medical expenses.
• The insurer is slow to pay, denies your claim, or offers less than you need.

How Much Do Car Accident Lawyers Charge In California?

The amount a car accident lawyer charges in California depends on factors like how complicated your case is and whether it goes to court. You may also be wondering, “Do lawyers only get paid if they win?” The answer is yes if they work on a contingency-fee arrangement. You only pay your attorney if they win or settle your case.

Get Experienced Legal Guidance For Your Health Insurance Claim Today!

Using your health insurance after a car accident can help you pay for medical care while you pursue compensation from the at-fault driver’s insurer. That way, you can get the treatment you need, even if delays or disputes prolong the claims process. Keep in mind that health insurance does not cover all types of care, and you may still need to meet deductibles or co-pays.

If you have more specific concerns about how to pay for medical care after a crash, consider consulting a car accident lawyer. The team at Arash Law can help you navigate the claims process. Our attorneys can explain your insurance coverage and assist with managing the necessary paperwork. We can also negotiate with insurers and handle appeals or court cases if needed. That way, you can pursue full compensation in accordance with your insurance policies and California law.

We work on a no-win, no-fee policy. In other words, we don’t charge legal fees unless your case results in compensation. To discuss your case, call AK Law at (888) 488-1391.