San Francisco, CA asked in Car Accidents, Health Care Law, Insurance Bad Faith and Personal Injury for California

Q: Can a car insurance bodily injury rep get my Medi-Cal info from hospital billing department?

I was in a car accident 4 weeks ago, the insured of the other car accepted liability. I have a Stanford Hospital bill of $15,574 and I was unaware that I had state health insurance that will cover emergency room visits. My health insurance provider name and group/member number was not listed anywhere on the itemized billing statements that I emailed over to the bodily injury rep. She asked if I had insurance that will cover this and I said no because I was told it doesn't cover ER visits. She called the number on the billing statements to Stanford billing or the hospital itself and called me back and told me I do have health insurance and they already paid for the visit because it's showing up as a $0 balance. She went on to tell me I lied to her to try and get the money myself or something which is not true. The statements I sent her shows I have a unpaid balance but she went in to double check. I didn't sign a medical release form or anything so, do she have the right to check?

4 Lawyer Answers

Theodore Allan Greene

Answered
  • Personal Injury Lawyer
  • Sacramento, CA
  • Licensed in California

A: It's hard to answer your question without more information but I can tell you that insurance companies do all they can to minimize how much they pay to people their clients (insured) injury with negligent driving. The health care provider will say that they haven't divulged any of your "medical" information.... just the billing information. You should seriously consider have a personal injury attorney help you because all the other people you will be dealing with will not have your interests in mind and will only want to maximize their interests.

William John Light agrees with this answer

Dale S. Gribow

Answered
  • Personal Injury Lawyer
  • Palm Desert, CA
  • Licensed in California

A: More info needed.

with meds that high you should have a PI attorney guiding you and looking into this.

they shouldn't be able to get confidential info but they do whatever they can to deny and delay payments.

i have confronted that here in Palm Springs recently......must be a new tactic.

William John Light

Answered
  • Personal Injury Lawyer
  • Riverside, CA
  • Licensed in California

A: She has the right to check, but should the hospital have disclosed it to her without a consent form? Maybe not. It could be a HIPPA violation.

Regardless, you are in over your head. Get a lawyer.

Justin R. Heim

PREMIUM
Answered
  • Personal Injury Lawyer
  • Seal Beach, CA
  • Licensed in California

A: I respectfully agree with the other attorney answers posted here, I think it is time that you consult with an attorney.

Medi-Cal is notorious for underpaying health care providers for services rendered. Thus, if you have Medi-Cal as posted in the topic, and they paid that much for your care, then I presume you've had quite a bit of medical care.

First of all, it seems like you and the adjuster are talking past each other about the dollar figure for your bills which you are citing. I cannot tell if you are looking at the amount billed or the amount paid. It sounds like the adjuster is talking about the remaining balance.

Medical bills and what has actually been paid matters a great deal in personal injury claims. You should discuss the bills with an attorney to figure out what you can recover. Generally, in California, you are entitled to recover the lesser of the reasonable amount for necessary services or that which is actually paid.

Of course, Medi-Cal will want their money back and will come calling if they think there is a third party payor such as an insurance company. Insurance companies don't want Medi-Cal coming after them later and will try and pressure you into providing them the Medi-Cal lien information if they don't already have it.

Talk to an attorney and figure out the best way to handle this. Otherwise, it sounds like this adjuster is going to try and attack your credibility as a means of devaluing your claim, a typical insurance tactic.

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