1. You are only required to carry a minimum amount of $5,000.00 in first party medical payments under the Pennsylvania Motor Vehicle Financial Responsibility Law (PMVFRL) to pay for auto accident related medical treatment under your personal auto insurance policy. First party benefits are paid for medical treatment that you need for an auto accident, regardless of who is at fault. Many people only carry the minimum amount of $5,000.00.
2. A healthcare provider must accept less than the face amount of a bill in satisfaction of its fee. Even with those restrictions your first party benefits can quickly be exhausted if you require more than just minimal medical care for the your injuries.
3. If you have private health insurance, your doctors will begin to bill them for your auto accident medical treatment when the first party benefits exhaust. When your health insurance company becomes aware that they are paying for treatment related to an auto accident, and you have a claim against someone else for causing those injuries, your private health insurance company may contact you to tell you they want paid back out of any settlement or recovery that you receive from your automobile accident. This is known as subrogation, or the right to reimbursement.
4. Your health insurance company is not always entitled to be reimbursed out of the proceeds you may receive for your automobile accident. The PMVFRL prevents your health insurance company from taking any of the recovery you get from the party responsible for causing your injuries and damages, except in certain circumstances. Your health insurance plan must either be an HMO, or a self-funded plan under the federal law ERISA in order to obtain reimbursement. The plan must also have language permitting subrogation.
5. If your health insurance company is trying to claim a portion of your settlement or recovery for an automobile accident, you should have an experienced auto accident attorney review your case to determine whether your health insurance company is actually entitled to subrogation. Even if you must pay back the health carrier, an attorney may be able to reduce what is repaid to maximize your recovery. You should also be aware that these rules only apply to private health insurance benefits, and not to situations involving Medicare, Medicaid, DPW, or other public and government benefits, where different rules apply. An experienced auto accident attorney can help make sure that, whatever the situation is, you are not giving up a portion of your recovery unless you absolutely have to do so.