Who is Supposed to Pay for the Medical Bills First?

After a car accident, the medical bills can start arriving with frightening speed. An invoice from the ambulance company, a massive bill from the emergency room, and follow-up bills from specialists. As they pile up on your kitchen table, a single, stressful question dominates your thoughts: Who is supposed to be paying for all of this?

It’s a massive point of confusion. The other driver was at fault, so shouldn’t their insurance company be paying for everything? While that is ultimately true, they do not pay for your treatment as it happens. They pay one lump sum at the end of your case in a final settlement.

So, who pays the bills that are due right now? The answer lies in your own insurance policies. In Washington State, there is a clear hierarchy of payment designed to ensure that your medical providers are paid promptly, allowing you to get the care you need without having to pay out-of-pocket.

Useful Information for You: In a Nutshell

• The At-Fault Driver’s Insurance Pays LAST: They do not pay your bills as you go. They pay at the very end in a single settlement.
• Your OWN Auto Insurance Pays FIRST: In Washington, your Personal Injury Protection (PIP) coverage from your own auto policy is the primary payer for your medical bills, regardless of who was at fault.
• Your Health Insurance Pays SECOND: Once your PIP benefits are used up, your personal health insurance (e.g., Premera, Kaiser) becomes the secondary payer.
• This Process Protects You: This system ensures your doctors are paid promptly, which prevents your bills from going to collections and harming your credit.
• The Insurers Get Paid Back Later: Through a process called subrogation, your PIP and health insurers are reimbursed from the final settlement you receive from the at-fault driver’s insurance company.

The First Payer: Your Personal Injury Protection (PIP) Coverage

Think of your PIP coverage as your financial first responder. It is a “no-fault” benefit on your own Washington auto insurance policy that is designed to provide immediate payment for medical expenses and lost wages after an accident.

How it works:

1. After the accident, you open a claim with your own insurance company and tell them you need to use your PIP benefits.
2. You provide your PIP claim number to all of your medical providers (the hospital, your doctor, your physical therapist).
3. Your providers will bill your auto insurance directly.

Your PIP coverage will continue to pay for all reasonable and necessary medical treatments until your policy limit is reached. The minimum PIP limit in Washington is $10,000, but you may have purchased higher limits.

The Second Payer: Your Health Insurance

What happens when your medical bills exceed your PIP limit? This is where your regular health insurance steps in to become the secondary payer.

How it works:

1. Once your PIP benefits are exhausted, you will provide your health insurance card to your doctors for all further treatment.
2. Your health insurance will then process and pay your medical bills according to the terms of your health plan. You will be responsible for any co-pays or deductibles, just as you would for any other medical treatment.

Why is this so important? Using your PIP and health insurance in this order ensures a continuous flow of payment to your medical providers. This prevents them from sending your bills to a collection agency, which can have a devastating impact on your credit score.

The Last Payer: The At-Fault Driver’s Insurance

The at-fault driver’s liability insurance is ultimately responsible for all of your damages. After you have completed your medical treatment, your attorney will gather all of your medical bills and submit them as part of a comprehensive settlement demand.

The final settlement you receive will be a single lump sum that is intended to cover all of your losses, including reimbursing your PIP and health insurance companies for the bills they paid on your behalf. This reimbursement process is called subrogation, and it is handled by your attorney at the conclusion of your case.

Navigating the complex flow of payments between multiple insurance companies is a daunting task, especially when you should be focused on your recovery. If you’ve been injured in an accident in the Tacoma area and are confused about who should be paying your bills, search the Car Accident Lawyer Directory Tacoma. Compare profiles and read reviews of experienced local attorneys who can manage this entire process for you, ensuring your bills are paid and your credit is protected.

References

• Washington State Office of the Insurance Commissioner (OIC) – Personal Injury Protection (PIP):The official consumer guide explaining that PIP is the primary payer for medical bills in a car accident, regardless of fault.https://www.insurance.wa.gov/personal-injury-protection-pip-and-how-it-works-your-auto-insurance-policy
• Washington State Legislature – RCW 48.22.085 – Personal injury protection—Mandatory, exceptions:The official state law that mandates PIP coverage must be offered on all auto insurance policies in Washington.https://app.leg.wa.gov/RCW/default.aspx?cite=48.22.085
• Washington State Office of the Insurance Commissioner (OIC) – Coordination of benefits (COB):A guide explaining the general principle of how different insurance policies (like auto and health) coordinate to pay claims.https://www.insurance.wa.gov/coordination-benefits-cob-and-how-it-works