Need Help/Advice
Hi everyone, I could use some guidance. I have a brain injury, so I apologize if my details aren’t as clear as they should be. I’m trying to understand how my auto insurance and health insurance work together. I’ve exhausted all of my PIP coverage, which amounted to $10,000. I believe my health insurance should also come into play, but I’m a bit confused about how it all fits together.
My health insurance deductible is between $8,000 and $9,000, and I need to clarify whether the PIP coverage has taken care of my out-of-pocket expenses. I mistakenly referred to these out-of-pocket costs as a deductible, but now I understand they are different. I was told by one insurance company that my PIP would cover these costs, while another seemed uncertain.
So, my new question is: how can I get both insurance groups on the same page? Is there a way to sort this out without involving more lawyers?
First off, it’s completely understandable to feel confused, especially when dealing with medical and insurance matters on top of your brain injury. You’re not alone in navigating this complex situation. Let’s break it down a bit.
PIP and Health Insurance: In Florida, Personal Injury Protection (PIP) is designed to cover medical expenses and, in some cases, lost wages, irrespective of who is at fault in an auto accident. Once you exhaust your PIP benefits, your health insurance typically comes into play for any remaining medical expenses, but the coordination between the two can vary.
Deductibles vs. Out-of-Pocket Costs: The deductible is what you pay out of pocket for your health insurance before coverage kicks in. Out-of-pocket costs include your deductible, copayments, and coinsurance. If your PIP has covered certain medical expenses, those may or may not count toward your health insurance deductible.
Billing Expectations: Since you’ve used all your PIP coverage, you might still be responsible for out-of-pocket costs if your health insurance requires a deductible before it starts covering expenses. However, the exact details can depend on how the providers bill and the specifics of your health plan.
Getting on the Same Page:
Ask for Coordination of Benefits: Inquire about how your PIP benefits have been applied and if they can be coordinated with your health insurance coverage. This will clarify if you owe anything or if your health insurance should cover remaining costs.
Avoiding Lawyers: If you want to avoid legal routes, you can consider contacting a patient advocate or an insurance broker. They can help negotiate or clarify terms between both insurance companies and help you understand your financial responsibilities.
Lastly, don’t hesitate to ask for clarification at any point during your conversations with the insurance companies—it’s their job to assist you. Take your time going through this process, and lean on family or friends for support if you need it. Good luck!