But medical bills seem so straightforward!
Chances are that if you're reading this, you're in the process of handling your own personal injury claim, or you've done so in the past. If that's the case, then good for you! A lot of the more straightforward claims can absolutely be handled without an attorney's involvement, and the cost of living these days is high enough without a guy like me holding his hand out for a chunk of your recovery.
However! If you are handling your own case, you need to have a long look in the mirror and do a serious risk/reward analysis. Write it down if you need to. The reward, basically, is that you handle your own case, you save yourself a chunk of change, and you get a sense of accomplishment from sticking it to the system. The risk, unfortunately, is huge; you fall into one of literally thousands of Personal Injury pitfalls, you ruin your case, and you get stuck with thousands of dollars in medical bills, lost wages, and other damages without any hope of redress from the person who injured you.
Scary? Good. It should be. The ramifications of messing up your case are enormous, and they shouldn't be taken lightly. Now that you're sufficiently terrified, then, let's talk about how you can preserve every dime of recovery that you're entitled to.
How does the process typically work?
After the accident occurs, and after you open your claim, the adjuster assigned to the case will typically follow up with you pretty quickly. He or she will ask for a few items of information, like a copy of the accident report, a recorded statement (DON'T DO IT!!!), a medical release (DON'T DO IT!!!), and/or any medical bills and records that may have been compiled with regard to your accident. A lot of people hear these requests and assume that they're required to comply with all of them in order to be compensated on their claim. A word to the wise; you aren't! The more information you turn over to the adjuster, the more weapons you're putting in the adjuster's hands. You can do yourself a lot of favors by controlling the output of information regarding your claim, because that's going to drive the adjuster's approach to the case.
The most innocent-seeming information that the adjuster will request is the medical information; bills always, records most of the time. Most people don't think twice about handing this stuff over; after all, it bears out the fact and extent of your injuries, and you can hardly expect the adjuster to take you at your word! And while that's certainly true - the medical bills and records are the most direct proof of your damages - you want to be careful about how much information you're turning over. We've already talked about over-disclosing in your medical records, but you may not know that your medical bills include a substantial amount of information that doesn't exactly jump off the page. That information, in the wrong hands, could have seriously bad ramifications for your claim.
Dates of Service
Each line item on your medical bill includes a "date of service," indicating when you were seen for each visit. These dates of service are important for a couple of reasons. Number one, it's going to give the adjuster an idea of how severe your injuries were and how extensive your treatment was. If you're claiming debilitating spinal injuries and your chiropractor bill only shows four visits, you can probably expect the adjuster to have some questions about that. The opposite is also true; if your only injury is a neck strain and your bills indicate a course of forty visits, the adjuster is going to look at your claim with a very suspicious eye.
The second reason is that your dates of service are going to indicate whether there are possible pre-existing conditions in your medical history. If your accident occurred on May 16th and your bills show similar treatments all the way back in February, then that's going to send up some serious red flags for the adjuster. That would then give him (or her) a foothold to threaten a denial unless additional bills and records are provided.
You remember billed-versus-paid, right? The North Carolina Rule of Evidence that limits your recovery to whatever medical expenses were actually paid, as opposed to what was billed? Well, your medical bills are often going to indicate the billed amount as well as any paid amounts. I know, duh.
What you'll often see, for example, is an original due amount of $1,000.00. Then there will be a couple of credits; one might say, "Insurance Payment" in the amount of $250.00, and another might say, "Contractual Discount" in the amount of $725.00. Then there might be a copay of $25.00. That means that under Rule 414, your actual damages are only $275.00 instead of $1,000.00; and of that $275.00, there's a great chance that the insurance carrier is going to want the lion's share.
So what do you do about that? Well, I normally ask the medical providers to send the bills with only the original billed amounts on them, without any indication of amounts paid or discounts. That allows me to submit a nice, clean demand without having to itemize paid amounts, insurance coverage, and all that business. It also has the pleasant effect of securing more recovery for the client.
If you look at your medical bills, you'll probably see one or more wacky numbers next to each date of service. These are "diagnosis codes," or as they're called in the medical field, ICD9 and ICD10 codes. These codes are indicative of the type of service that you received at that visit, or the injury that you sought treatment for. For example, if you see "S12.200A," that's going to mean that you sought treatment for a fracture of your third cervical vertebra. It's (somewhat) easy to look these codes up online, and you should do so for each code on your medical bills before you provide them to the adjuster.
Why? Well, you can bet that the adjuster is going to review the diagnosis codes, and anything that he doesn't believe is related to the accident is going to be taken out of your recovery. You can establish credibility with the adjuster by reviewing the codes first and making sure not to demand compensation for unrelated treatments. Another reason for doing that is that your insurance carrier might review the bills and claim a right of recovery against unrelated treatments, and you need to have some familiarity with your bills (and the diagnosis codes pertaining thereto) in order to educate the carrier on why they aren't entitled to be reimbursed for that particular treatment.
Sounds simple enough.
True; while time-consuming and often involved, a thorough review of your medical bills won't take up too much of your mental bandwidth. Remember that you aren't obligated to turn over information that isn't relevant to your injuries and the accident; it's okay to tell the adjuster no, and it's okay to redact information from your bills and records if that information isn't relevant. Take a few minutes to look everything over before you send it to the adjuster; those few minutes could ultimately make your life a whole lot easier.