Do I Need to Use My Own Health Insurance?
After a Pennsylvania motor vehicle collision, your auto policy pays medical bills first, and health insurance steps in once those auto benefits run out. Outside of motor vehicle cases, the order flips: health coverage pays from the start and is reimbursed later from any settlement. Stine & Associates helps injured clients across western Pennsylvania sort out which policy pays.
How Are Medical Bills Paid in Pennsylvania?
Pennsylvania routes crash-related medical bills through a two-tier system. Which tier pays first depends on your coverage limits and on an election, you made when you bought the policy.
First Tier: Auto Insurance / PIP
Your own auto policy pays first through personal injury protection (PIP), also called first-party medical benefits, and it pays no matter who caused the crash. Under 75 Pa.C.S. § 1711, every Pennsylvania auto policy must carry at least $5,000 in medical benefits.
Second Tier: Health Insurance
Your own health insurance takes over once auto medical benefits are exhausted, applying its usual deductibles and copays. That order can flip entirely, because Pennsylvania permits drivers to elect coordinated benefits in exchange for a lower premium.
That election makes health insurance primary from the very first bill, catching many people off guard when their auto carrier denies treatment they assumed was covered.
Personal Injury Accidents Beyond Motor Vehicle Accidents
Personal injury protection applies only to motor vehicle crashes. Other personal injury cases in Pennsylvania run through personal health coverage from the beginning. Examples of these claims are as follows:
- Slip and fall injuries on someone else’s property
- Dog bites and animal attacks
- Defective product injuries
- Injuries at a business or rental property
- Harm caused by unsafe conditions at a public site
Workplace injuries follow their own track through workers’ compensation. In those cases, the compensation carrier pays medical treatment directly and holds a separate right to repayment out of any third-party recovery.
Health plans that pay accident-related treatment usually assert a lien against your settlement. Several steps protect what actually reaches you, such as:
- Requesting the written lien amount early
- Checking whether the plan is self-funded or state-regulated
- Asking about reductions for attorney fees and costs
- Keeping incident-related treatment in a separate file
- Confirming what the plan paid rather than what was billed
The spread between billed charges and paid amounts is often substantial. Reimbursement typically gets calculated on the paid figure, which brings the lien down considerably.
Let Stine & Associates Sort Out Who Pays Your Medical Bills
Health plans, auto carriers, and workers’ compensation insurers each keep their own ledger, and none of them will explain how the others fit together. Stine & Associates handles that reconciliation as part of every injury case, from the first statement through the final lien reduction.
Our number is (724) 837-0160, and a consultation costs you nothing. No fee is owed unless and until an award or a verdict comes your way. You can also send your questions to our Greensburg office online.