Does Health Insurance Cover Car Accidents in Florida?
Understand how medical bills are covered after a Florida car accident. Learn the typical order of insurance payments and when health insurance plays a role.
It is common for individuals to feel uncertain about how medical expenses are covered following a car accident in Florida. The interplay between various types of insurance can be complex, leading to confusion regarding payment responsibilities. This article aims to clarify the roles different insurance policies play in addressing medical bills after an automobile collision in Florida.
Primary Coverage in Florida Car Accidents
Florida operates under a “no-fault” insurance system for car accidents, meaning that your own insurance policy is generally responsible for covering your medical bills and other related losses, regardless of who caused the accident. This system primarily relies on Personal Injury Protection (PIP) insurance. All drivers in Florida are legally required to carry a minimum of $10,000 in PIP coverage.
PIP insurance is designed to provide immediate coverage for medical expenses, lost wages, and death benefits. Specifically, it typically covers 80% of reasonable and necessary medical expenses resulting from the accident. Additionally, PIP can cover 60% of lost income if injuries prevent you from working, and provides a $5,000 death benefit. PIP coverage extends to the policyholder, relatives residing in the same household, and passengers who do not have their own PIP insurance.
A crucial aspect of Florida’s PIP law is the “14-day rule,” which mandates that injured individuals seek initial medical treatment within 14 days of the accident to qualify for PIP benefits. Failing to obtain medical care within this timeframe can result in the denial of PIP claims. If a medical professional determines that the injury constitutes an “emergency medical condition,” the full $10,000 PIP benefit may be available; otherwise, benefits might be limited to $2,500 for non-emergency injuries.
When Health Insurance Provides Coverage
Health insurance typically serves as a secondary payer for car accident injuries in Florida, meaning it generally becomes relevant after your Personal Injury Protection (PIP) limits are exhausted. Once the $10,000 PIP coverage is utilized, or if medical expenses exceed what PIP covers, your health insurance policy may then begin to pay for remaining medical costs. This includes expenses such as hospital stays, surgeries, medications, and rehabilitation treatments.
Health insurance may also step in for medical expenses that PIP does not cover, such as the 20% co-payment not covered by PIP. In situations where an individual does not have PIP coverage, such as certain pedestrians or bicyclists, health insurance might act as the primary payer, depending on the policy’s terms.
It is important to review the specific terms and conditions of your individual health insurance policy, as coverage details, deductibles, co-pays, and network restrictions can vary. Some policies might have exclusions for auto accident injuries, or they may require reimbursement through subrogation if you later receive a settlement from an at-fault driver. Government-funded programs like Medicare or Medicaid typically cover medical expenses once PIP is exhausted, but they may also seek reimbursement from any settlement you receive.
Steps for Handling Medical Bills
You should seek prompt medical attention within 14 days of the accident to ensure eligibility for PIP benefits. After initial medical care, notify both your auto insurance provider and your health insurance provider as soon as possible.
Collecting and organizing all relevant documents is a necessary step. This includes accident reports, all medical records, itemized bills from healthcare providers, and details of your insurance policies. When submitting medical bills, your healthcare providers will often bill your auto insurer directly for PIP coverage. It is prudent to verify that your medical providers are correctly submitting these bills to your PIP carrier first.
Once PIP benefits are exhausted, submit any remaining medical bills to your health insurance provider. This typically involves providing your health insurer with an Explanation of Benefits (EOB) from your auto insurer, showing that PIP coverage has been applied and its limits reached. Ensure medical providers bill the correct insurer in the correct order and follow up on discrepancies. Maintain detailed records of all treatments, bills, payments, and communications. If a claim is denied, you have the right to appeal by understanding the reason and submitting additional documentation.