Can insurance company deny to pay medical bills baed on reasonable and customary fees?

Question

I got injured in an auto accident from other driver. His insurance company doesn't want to pay my entire medical bills only a portion of it. There reason is that they owe only reasonable and customary fees. They say that medical bills are unreasonable and "inflated." It seems like they only want to pay based on what is reasonable to them and want to me to pay the rest of the bills on my own.

William John Light · Answer

Until you get a judgment against the at fault driver, his insurance company can refuse to pay you anything at all, so it is certainly entitled to dispute your medical expenses.   
 
It appears that you are attempting to handle a personal injury claim by yourself.  The insurer is not taking you seriously because you pose no threat of successfully litigating your claims against the at fault driver.  Before you do anything else, contact a personal injury attorney to discuss your claims.  Studies show that persons with attorneys receive more net in their pocket, than unrepresented persons.

Maurice Mandel II · Answer

Hope you are doing better. You need a personal injury attorney. This is how insurance companies operate and they take advantage of you if you are representing yourself.  You should contact an attorney practicing in this area of law right away.  Thank you for using Justia ask a lawyer.

Tim Akpinar · Answer

My colleagues offer sound advice in terms of seeking the guidance of an attorney. You could try to arrange a free initial consult without obligation to discuss the case. In terms of reimbursement IN GENERAL, those can be region-specific around the nation, based on what fee schedules are applied (depending on jurisdiction, no-fault, w.c., public health systems, etc.) Only a local attorney could advise on any fee schedules, if applicable. Good luck

James L. Arrasmith · Answer

I'm sorry to hear about your situation. Dealing with an insurance company that refuses to pay your full medical bills can be frustrating. When it comes to health insurance, policies often cover medical expenses based on "reasonable and customary fees," which represent the average cost of a specific treatment in a particular area. However, the determination of what is reasonable and customary can vary among insurance companies. In your case, the other driver's insurance company claims that your medical bills exceed their determined limits and are inflated. They are willing to pay only a portion of the bills and expect you to cover the rest. It's important to review your insurance policy, gather documentation, negotiate with the insurance company, and, if necessary, seek legal advice to ensure you receive the coverage you are entitled to based on your policy's terms.

Q: Can insurance company deny to pay medical bills baed on reasonable and customary fees?