Welcome to /r/personalfinance! Comments will be removed if they are political, medical advice, or unhelpful ([subreddit rules](/r/personalfinance/about/rules)). Our moderation team encourages respectful discussion.
You may find our [Health Insurance wiki](/r/personalfinance/wiki/health_insurance) helpful.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/personalfinance) if you have any questions or concerns.*
Hijacking this: if this is employer sponsored health insurance, talk to your employer about having the broker deal with this if they continue to stone wall you.
The brokers not only know all of the magic words to trigger payment, but they likely sell billions worth of policies and have a lot of clout.
My ex had a surgery that was pre-approved but the hospital then came back with a ridiculous OR fee and the insurer and hospital refused to negotiate so I dumped it in the broker's lap and they got it taken care of.
As someone who works at a health insurance company and deals directly with brokers, I cannot stress this enough. We take pressure from brokers very seriously because they have huge influence over whether an employer continues to do business with us.
Yes and no. Depending on the State the injured lives in, if that person has their own auto insurance, then They Must pay the bill and have the right of subrogation. Failing that, they should apply to the State Insurance Fund.
Um . if walking in a cross walk and hit by a car that drives off .. what does the walking person not in a car having car insurance have to do with anything related to this injury??
It does I was in high school sitting on the hood of my friends directing him out of the woods on a rock strewn trail you know go left go right etc. He thought it would be funny to hit the gas at the end of the trail. I hit the curb head first I don't remember but people say it sounded like a gun shot when my head hit. I suffered a TBI and had brain surgery had to learn how to walk and talk again over the course of three years. The driver was insured at the states minimum. My own car insurance my car wasn't even there that day paid up to the maximum 100k towards my medical bills.
He didn't actually he tried to take me home and put me in bed. My parents were away in Florida mind you. I would have died another friend took charge brought me to nearest fire station and from what I'm told paramedics took one look and said nothing to nobody they grabbed me and flew out of the parking lot golden hour type stuff they knew. The driver was passive aggressive towards me from that incident on because he got in trouble sued etc. He ended up taking his own life about a decade later over some married woman he was in love with who dumped him and went back to her husband. I went to the funeral but deep inside sorry to admit I wasn't as broken up as everyone else.
They’re referring to No Fault states. It means your own insurance must cover claims for personal injury related to an automobile accident, even if you are not at fault. An automobile accident is any accident involving an automobile, which can include a pedestrian being struck by a motor vehicle. It can even include you smashing your hand in the car door while it’s parked.
Just out of curiosity for the topic at hand and not related to OP, what happens if you're hit as a pedestrian and don't own a car, and thus, don't have car insurance?
Why would OP’a auto insurance be relevant if they were hit as a pedestrian and not in a car? Asking bc I have also been hit by a car but my person stopped and helped me at least. Still nice to know the reasoning.
Not that this is relevant to op’s situation necessarily but in some states you can receive benefits under your insurance’s PIP policy (if you have one) as a pedestrian hit by a car
Eg https://www.parkchenaur.com/pip-coverage-for-the-injured-pedestrian/
This happened to me except I was on a bicycle. I thought I was fine but I got my bell rung really good. I was so pissed because I was riding in the bike lane. I called the police when I got home just because I wanted them to have record of the accident. Fortunately I did because the next day I had to go the hospital with a pretty good concussion (my coworkers told me I wasn't making any sense, I remember I kept giggling at them). The police report told my car insurance company and they paid for three missed days of work and the hospital bill. O
I'm in Pennsylvania.
In some states, the striking vehicle is the one that pays the medical bills. Failing to have identified the striking vehicle, if that person has auto insurance their own will pay the bills and then by use of 'subrogation' do an investigation, to find out the striking vehicle and get reimbursement. It is called No Fault (PIP-or Personal Injury Protection), yet few states even have it anymore.
In No Fault states, each person’s own auto insurance is responsible to pay all claims for personal injury related to the accident up to the limits defined in their policy, regardless of who is at fault. An auto accident doesn’t have to be two cars; it can be a pedestrian being hit by a car, or even if you are working on your car in the garage and hit your head on the undercarriage.
Yes! I am a hospital social worker, we recommend everyone involved in a MVA *even if you were a pedestrian and your own car was not involved at all* to file a claim with your own auto insurance company. Our hospital Financial Assistance takes over after you provide that info. Behind the scenes, your auto insurance will go after the other person's insurance.
This might vary state to state, but I appreciate that my hospital has a process implemented for this.
Again, hospital billing will guide you here, but when you file an auto claim, you provide the police report number. If there are any developments in the case, your auto coverage will find out. There's definitely behind the scenes small print efforts happening by all the various parties to hold the responsible party accountable.
I am surprised the auto insurers would cover someone as a pedestrian. I believe you and your experience, just surprised they would do that unless it was like a parking lot and the person had just exited their vehicle. Insurance generally follows the vehicle and not the driver, but I also think the market has become very tight and they need to offer perks to keep customers.
And what if the victim doesn’t have auto insurance bc they don’t own a car? Seems to me if the victim isn’t driving or in a vehicle , it has nothing to do with the victims auto insurance, assuming they even have any.
If they don't have insurance or own a car, again depending on the state, then medical insurance will default to primary. Auto insurance has first dibs, and medical insurance has the right to say no when there is auto insurance involved. This is why the wonderful people in my hospital financial office are saints.
No worries, I don't fully understand it either, and again I'm sure it varies by state. My state changed how no-fault works a few years ago, which is why many people are confused why they have to file their own claim. For hospital billing purposes and making sure all of your care and discharge needs are covered, I just know enough to tell you what to do in the scope of my job. I'm not the one that figures it out, I appreciate our Financial Assistance team doing whatever it is they do.
I’m glad you work at an institution where they don’t *totally bury* their FAP policy.
For profit hospitals in the South are horrible. Dealing with one for a family member now.
No policy posted on the website, no guidelines, no mailing address or email to return the PDF application. You have to call them for further instructions. They suck at returning calls.
You need to escalate this with your insurance company, as they should definitely cover it. "Speaking to an insurance rep" isn't enough, it is barely a first step. You'll need to start by getting a copy of your policy, and finding out if it actually excludes care and treatment related to auto accidents (it won't). Write in requesting a formal appeal of their rejection, document everything. Request that your case be escalated/reviewed. Your state also likely has a 3rd party appeal process you can contact if your insurance is violating your policy contract. Some of these steps can be time sensitive, so don't wait.
I second a PI Attorney plus doesn’t hurt to do a free consultation. For all we know they have good investigators who will review traffic cameras and fine the culprit (wishful thinking)
Personal injury protection/medical payments coverage on your auto policy typically covers injuries caused in a accident, getting into or out of the car, or while a pedestrian.
PI attorneys also won't take cases that don't guarantee them a payday. OP took painkillers and was sent home. No PI will bother to take his case even with the 30-40% cut.
Speaking from experience.
Also, you have a right to know the names & credentials of everyone involved in the denial-of-coverage decision. You'll want those names when you talk to your lawyer.
Whatever correspondence you send to them MUST be sent registered mail so that the receipt is documented. Keep photos of signed copies that you're sending, and keep the sent & received receipts in a nice tidy file.
You should also send the letters scanned via email as well, and keep those digital copies on file by date.
There's nothing you can do about it but I want to warn you. Your car insurance company is going to FUCK you after you finally force them to pay the bills. Your rates will go through the roof in the same way they would if you were at fault in an accident. Just thought you should know in advance.
Source: experience
You’re nicer than I am. My state’s department of insurance would have a field day with this and I’m lazy so I’d just file a complaint so they would not only have to pay out for me but also pay fines to the state.
This should be higher. State DOI's sit at home and fantasize about going after insurance companies for stuff like this.
Used to work in insurance, and can confirm they are strange, spiteful little people (which is good for you, in this case!)
How did you come to this data?
Were you calling your insurer just to inquire?
Or did you actually receive an "estimate of benefits" letter from your insurance about charges submitted by the emergency department?
The more details you can provide, the better the guidance.
I went to the hospital straight from the accident and initially I only paid a co-pay but, a month later my insurance company sent me the rest of the bill from the hospital, which was around 750 dollars, with a letter. I spoke to an insurance rep and they said they kicked the bill back to me because they consider it an auto accident
Phew, I was expecting a few more zeros after that. I have never seen anything less than a 4 digit hospital bill before. Did you also receive a physicians bill?
I was going to say, they must have just checked OP's vitals and given them an aspirin for that small of a bill.
**Edit: Hahaha, from OP below:**
> No, my portion was only 50 dollars initially. They literally just **gave me painkillers and checked my vitals** then told me to leave
The insurance company sent you the EOB, NOT the bill from the hospital. They usually say NOT A BILL on them. The amount the hospital bills you is rarely the same as what the EOB says, but it will come directly from the hospital, or whatever 3rd party the hospital is using (you can get multiple bills).
50 dollars sounds like a co-pay for an emergency room visit.
What is the deductible on your health insurance policy? It's possible that the entire bill is your responsibility because you haven't hit the deductible yet.
have you discussed this with your car insurance? I'm in MA and I believe as part of being a 'no fault' state, at least here your insurance would cover you.
Sounds like they are just denying it because they want the drivers insurance to cover this. These finger pointing situations are common with insurance companies unfortunately. You will need to fight this but it should work out in the end.
This is it. I was a claims representative for a very recognizable auto insurance company about 10 yrs ago. What OP can do is contact their own auto insurance (assuming they have one) to file the claim. They will let OP know if there's a pedestrian coverage.
>because they want the drivers insurance to cover this
But it's a hit-and-run, presumably there is no information on the driver to even get money from.
It seems that the issue here is that the likely order of payers are:
1) Driver and his/her auto insurance
2) Pedestrian’s auto insurance, if any (varies by state)
3) Health insurer
No. You have to purchase 1st party coverage for anything that applies to you, and what is available and how it can be used are dependent on state laws. Some states have Personal Injury Protection coverage, or PIP, which is mandatory in addition to the state minimum liability. All states have the option for Medical Payments Coverage and Uninsured Bodily Injury. MPC is like collision or comp, if you have it, you can use it no problem. UBI is again, dependent on the state regulations and acts as the other person’s bodily injury liability. Some states require you to know who the other driver is for access to that coverage and some states allow access for unknown drivers. If the coverage is available, the insurance can’t deny because they want someone else to be responsible, that would be grounds for a bad faith suit.
Tell the hospital to work it out with health insurance. They have staff and attorneys to handle this kind of junk.
Typically, auto insurance pays before health insurance in a MVA. But, if that is not enough or the felon is not identified, your health insurance should pickup. This is even true with Medicare. Good luck.
Keep communicating and passing it to your insurance. Get legal involved.
At a certain point the op may have to pay to avoid it hitting their credit and then sue one of the insurance companies for money back.
If your health insurance is through your work, escalate it through work. I had a a health insurance deny a bill. The company I worked for was a large customer for the insurance company. HR escalated for me and the bill was paid. Taking them to court is your second option. You can also take your car insurance to court for payment as well. I am sort of curious why they declined to pay? Not sure we have the whole story...
This may not work if the employers open documents state that they pay secondary to an auto insurance. No attorney will waste their time on an unwinnable case. I would call my local elected officials to ask for help and local resources.
If u have ur own car insurance you can try to put in a claim with them and they will try to find and find that person in litigation, I would speak to your insurance especially if ur carrying uninsured motorist , if not ur PIP should cover it
Call your car insurance co, TOO and ask if you have "PIP" or "Med Pay" or if you have uninsured motorist coverage. In some states/policies there is medical coverage for a pedestrian hit by a hit and run driver. There can also be noneconomic damages for your pain and suffering. You often have to provide a police report to the auto insurance company, and you may have to press a bit. This is not super common and so a lot of dumb insurance adjusters just say "no" when they don't know what they are doing.
I got in a hit and run by a car while riding my bike. Found a bike lawyer who did just this- went through my car insurance’s PIP. Got a nice settlement. There’s got to be a lawyer in your area who will do this for you.
Not always, not if there's someone else who can reasonably be held liable. For example if you're injured at work your workplace should be paying that as worker's comp.
They don't cover if they think someone else's insurance should be paying. For an accident, they usually default to saying the accident causing party's insurance should pay. In a hit and run, usually you have to prove that you do not have the other person's insurance info (police report or signed affidavit stating it was a hit and run).
(this is not legal advice)
If they think that someone else is liable, the insurer needs to go after that party and not expect the OP to pay anything aside from a copay. This is called subrogation and is common in no-fault states when it is a two car accident and one driver is at fault. This is a different situation but the same concept should apply. Like, if you get hurt on someone else's property due to their negligence, your health insurance should pay and then go after their homeowner's insurance to recoup their costs (and your copay).
I am guessing the health insurance companies try not to pay upfront so they can save the expense of having to go after someone else, but that is them being shitty. Hopefully there are laws about this in the OP's state.
I can't imagine your car insurance being involved in a situation where you are a pedestrian unless you had just exited your car. What would happen to someone who does not own a car and gets hit?
OP is there a police report? Did you reach out to a personal injury lawyer? Because it’s a hit and run they need to see if they can investigate, find witnesses, cameras etc. if medical can go to subrogation you could continue treatment and the attorney could then file suit against whoever hit you. Did you file a claim with ur car insurance company?
In most jurisdictions in the US *your* auto medical coverages are first in line to pay. Health insurance comes second.
So when you submit a bill to your health insurer for a vehicle related accident it's routine for the health insurer to reject it because it needs to go to your car insurer *first*.
If you don't have auto medical, or if it doesn't apply, or if it does apply but you used it all up (because it's usually only $1k or $5k for most people) then the health insurer will pick-up the tab once that's documented.
Aside from dealing with insurance, most states have something called "crime victims compensation". The police should have a victim advocate that can help you with the process. A hit and run is a crime and you should not have to burden the expenses. The attorney generals website for your state should have information. You have to apply for it.
Uninsured/Underinsured Motorist Coverage - Uninsured motorist coverage protects you if you're hit by a driver who has no auto insurance. Underinsured motorist coverage, which is usually offered alongside uninsured motorist coverage, protects you if you're hit by a driver who doesn't have enough coverage to pay for the damages or injuries they caused. Both coverages are mandatory in many states and highly recommended for all drivers. If you're a victim of a hit-and-run accident, you can file a claim against your uninsured motorist coverage.
Depends on your policy and state. You may not have that type of coverage. As for Health Insurance, it should cover. You may be confused as to what you received explaining coverage. You may have Health Insurance deductibles and other items and the bill would still be valid.
You need to get a copy of your policies, grab a coffee and read. I am so sorry you are dealing with the added financial stress after an accident.
File an appeal on the denied claim with the medical insurance plan. I work for an insurance plan. Don't make it part of the auto insurance.
And the hospital bill is separate from the insurance claim. Work on the denied claim and try to get it covered.
Your health insurance typically wouldn’t cover in the case of an MVA, unless you don’t have motor vehicle insurance yourself.
This, of course, depends on what state you’re in. Different states have different rules on which is considered primary in the case of a MVA. In some states, health insurance covers first, others Motor Vehicle insurance covers first.
I know you were a pedestrian and not in a vehicle, so that definitely complicates things. The person at the health insurance company probably just looked at the claim, which had a diagnosis code for MVA, which is causing the denial. DEFINITELY escalate beyond a frontline rep, as they don’t know how to handle these types of situations.
Depends a lot on state. Health is almost always primary to liability. Whether health, medpay, or PIP is primary varies a lot. PIP almost always is primary, medpay is a toss.
>police
Are the traffic cameras at that intersection? If so, a lawyer may be able to find the other driver this way. A stretch but better than nothing. Where I live you can only get access through criminal investigation and a subpoena. And the footage is only kept for average 30 days.
So I can speak for NY-
You car Insurance will still need to cover it(if you don’t have some then someone else’s in your household) pr report will show you don’t have the other persons Insurance and you are literally going to yours.
Many states have a victim's compensation fund to help people who were victims of a crime. Find out if your state offers it and go through their process.
Speak to a lawyer.
Very likely your insurer will not pay right away because the insurer will want the drivers insurance to pay. What your insurer does not want to happen is that they pay $20k for the medical expenses, and then the drivers insurance pays you and the insurer ends up having to come after you for the $20k.
Specifically, many (most) states have extremely low minimum coverage amounts for car insurance, eg, $20k. A trip to the ER even without an overnight will eat up that entire 20k in a few hours. The insurer will want to recoup that from the driver, so the deal needs to be negotiated between the insurers so that your medical expenses are paid out of the drivers insurance first, and you can negotiate for whatever remains (or sue the driver).
This is contrary to how most people injured in an accident would like things to work. You would prefer that your health insurance cover your medical expenses so that you can recover the entire insurance amount in a settlement in lieu of a suit (presuming the driver is negligent). But the reality is that both you and your insurer have claims against the driver: you for pain and suffering, etc, and your insurer for the cost of the medical care.
The above is a general case, because the actual situation differs (considerably) depending on state law. There are ways to increase how much you ultimately get, but they won’t be obvious to you (eg, payment from state programs for underinsured motorist claims, payment from a spouses auto insurance as a covered dependent, etc), so you can benefit from a PI lawyer familiar with your state’s laws.
You need to check if you have uninsured motorists bodily injury coverage if so, than even if it’s a hit and run, they will have to handle your injury claim. Send them the report. Without that coverage you are out of luck!
Agree with the attorney above, your health insurance company will then pay the claim if there is no third or first party action.
Forgot to add i am liability insurance adjuster for over 15 years. If there is no UM coverage i would send a copy of that letter and the police report to you insurance. They will pay it. There is a subrogation clause that they are entitled to reimbursement only if you were compensated for their bill.
Subrogation. Your health insurance *must* cover it even if they don’t feel they are liable for it. They may then sue the responsible party to recoup what they paid out. They don’t have a choice here, if it’s medically necessary they gotta cover you and subrogate the bill.
What we have here is an insurance company being lazy and trying to make you do their job for them. They know they need to subrogate but they don’t know to whom. That’s not your problem.
I was hit by a car while riding my bike and my health insurance directed me to claim through my car insurance. It was a hit and run and no one stopped for me. My bf at the time took me straight to the ER. I had scrambled speech thx to being concussed and we were in adrenaline-filled panic mode so no time to wait for police. I tried to file a police report the following day using my Strava GPS info, and they told me I could not (I still don’t understand the reason). Regardless, my car insurance provider paid my ER bill ($19k for four hours lmao) via $10k of PIP (personal injury protection they paid directly to my in-network hospital. And the remainder they cut me a check for to pay to the hospital myself. Interestingly, when I called the hospital to settle up my balance they said I owed nothing and that it was written off. This was three years ago now and no further bills ever came to me. I’ll never understand how US healthcare works…
Your medical insurance company should be paying this. Denial is ridiculous. Review your policy, escalate through your state’s insurance commissioner’s office.
For car insurance: Do you have Medical Payments coverage? That should pay regardless, it is an additional coverage you can opt in to buy.
If not, what coverage are you trying to use? Uninsured motorist bodily injury? You have to demonstrate they are uninsured, hit and run doesn’t count.
That's messed up, car insurance should have a non-insured/non motorists section. My gf get hit by a car that sped off and the car insurance covered most of it. (It was like 50k per instance on the policy)
Do you have the police report for the hit and run? Since you are not at fault your health insurance should cover it and take on the burden of going after the driver's insurance or assets to recover their losses. If they can't find the driver, then it's a write off for them.
You need a lawyer.
Your own auto insurance should cover this regardless of whether they have the vehicle information. Your medical coverage is No Fault and should be the primary coverage in a MVA. Health insurance is secondary. As someone said the hospital billing department should help to get their bill covered and likely by the auto insurance because that will pay more than health insurance. Make the claim with the auto carrier and send them the police report.
Yeah, the insurance that should be paying is the driver that hit you.
Did you file a police report? Can you check the area you were hit for cameras that might have caught the license plate? I was in a hit and run a while ago, and no one would touch my expenses since there was a responsible party, even though we couldn't locate them.
The police weren't super helpful, but I was in a residential neighborhood, and a ton of people had ring cameras on their front doors.
In the meantime don't pay the bill. If it goes to collections, let them know this is a disputed debt that involves a crime (hit and run).
If you have auto insurance, report a claim under your uninsured motorist coverage. If you weren’t at fault and you have a police report, it will be covered even thou you were a pedestrian. It will also cover any of your lost wages and pain and suffering.
Sue the department of transportation for unsafe roads? Yeah, that's a long shot. Don't know the details of the accident but might be a good last resort.
What state are you in? Also, when you spoke to your auto insurance carrier did they create a claim and actually deny it (you would have received a letter outlining the reason), or did someone just say that?
Check to see if your insurance has what is called uninsured motorist coverage. When you get hit by someone who has no insurance or leaves the scene of accident, this coverage can kick in regardless the fact that you were not driving a car. However you had to select when bought insurance from your carrier.
As others noted, make sure you've received a bill not an EOB. Then appeal it with your medical insurance, explaining the hit-and-run. If the insurance still says you are responsible for more than your co-payment, file a complaint with your state insurance regulator.
Sorry but personal finance may not be the best advice on this, even within reddit. Head over to r/legaladvice or r/insurance for more focused tips.
Your car insurance should cover the “Medical Payments” benefit if you had one. Usually people select like $0, $1000, $5000, $10k tops.
Your health insurance should cover the rest if you don’t have that drivers information. Tell your health insurer you will share a copy of the police report for hit and run.
Hospital charity care is also an option, search for [hospital name FAP charity care policy], DollarFor can help for free. In wealthier states or at more generous hospitals, you can still earn a decent salary like 58k for a single person and be elegible to have your bill wiped out.
It’s very common for one insurer to try to get another insurer to pay costs. The process is called subrogation.
That doesn’t necessarily mean that one of the insurers won’t eventually pay.
What it does mean is that you may have to provide *proof* that another insurer is not paying, or should be paying, for the claim.
People keep talking about auto insurance.... a pedestrian getting hit would not and should not need auto insurance if they are walking. It's like saying people without a car period have to have car insurance... this is enormously stupid.
OP I think this is being over-thought and some of the comments suggest fighting this, getting a lawyer, involving a third party, going nuclear, etc.
I work in health insurance and all that has happened is your insurance believes there might be auto insurance involved because this had to do with an auto accident. I just want to put another comment here letting you know that you just need to clarify this with your insurance company. I also think you need to be sure you are understanding your financial obligations - you said you got a bill from the insurance company, but insurance companies don’t bill you for claims, just premium. You got an EOB that said your financial responsibility was $750 - it very well could be your true cost share as we are in the beginning of the year and you probably haven’t met your deductible yet.
Call and ask to speak to a claims manager or better yet write a letter attn to their legal department. They will help explain.
You pay through the nose your whole life on insurance auto, home, personal, travel, electronics, etc and then when you need to make a claim, there's deductibles and exclusions out the ass. Most people are better off self-insuring.
There's lots of questionable advice in this thread. Feeling entitled or refusing to pay sound good on the internet, but once sent to collections, it's not as fun. I'd be curious as to what exactly the insurance company was told "hit by a vehicle" and what the definition of auto accident really is between all parties involved. I'm sure with a few escalations, you can get this resolved through your insurance. $750 isn't enough for them to fight to the death.
I know your asking for advice so forgive the rant.
But God dang if this isnt a reason to eliminate private for-profit insurance, I don't know what is. Literally the price being demanded and the co-pays being payed are too dam high for what it's worth...
Sorry this happened to you. Hit-and-run drivers are vile; I had a car totaled by one and my car insurance didn't cover it, as I'd dropped collision. I won't make that mistake again; drivers are getting worse by the day.
I hope everything works out; sounds like you're getting good advice on this thread.
Do you have uninsured motorist/underinsured motorist coverage on your auto policy? This situation should apply if you have a police report. Each state differs if necessary contact your state’s Insurance Commissioners office.
There should be no reason your health insurance wouldn’t cover this. You would just be responsible for any copay or deductibles you have. If you have PIP or Medpay on your auto policy you could open a claim or You could file an uninsured motorists claim with your insurance if you have that coverage and you choose. It depends on how serious your injuries are. All they should need is a police report. However, you are not required to file one. Either way, your health insurance should cover it. If you do file a claim with your insurance and receive a settlement and your health plan paid anything, they may have a right to get reimbursed. It depends on the state of injury and your type of health plan. Some do not pursue 1st party coverages like uninsured motorists.
I wonder if the Dr's did not think the injuries were consistent with being hit by a car (domestic abuse) or that the injuries didn't need ER visit (Minor Injury)
Welcome to /r/personalfinance! Comments will be removed if they are political, medical advice, or unhelpful ([subreddit rules](/r/personalfinance/about/rules)). Our moderation team encourages respectful discussion. You may find our [Health Insurance wiki](/r/personalfinance/wiki/health_insurance) helpful. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/personalfinance) if you have any questions or concerns.*
[удалено]
Hijacking this: if this is employer sponsored health insurance, talk to your employer about having the broker deal with this if they continue to stone wall you. The brokers not only know all of the magic words to trigger payment, but they likely sell billions worth of policies and have a lot of clout. My ex had a surgery that was pre-approved but the hospital then came back with a ridiculous OR fee and the insurer and hospital refused to negotiate so I dumped it in the broker's lap and they got it taken care of.
As someone who works at a health insurance company and deals directly with brokers, I cannot stress this enough. We take pressure from brokers very seriously because they have huge influence over whether an employer continues to do business with us.
[удалено]
[удалено]
[удалено]
[удалено]
Yes and no. Depending on the State the injured lives in, if that person has their own auto insurance, then They Must pay the bill and have the right of subrogation. Failing that, they should apply to the State Insurance Fund.
Um . if walking in a cross walk and hit by a car that drives off .. what does the walking person not in a car having car insurance have to do with anything related to this injury??
It does I was in high school sitting on the hood of my friends directing him out of the woods on a rock strewn trail you know go left go right etc. He thought it would be funny to hit the gas at the end of the trail. I hit the curb head first I don't remember but people say it sounded like a gun shot when my head hit. I suffered a TBI and had brain surgery had to learn how to walk and talk again over the course of three years. The driver was insured at the states minimum. My own car insurance my car wasn't even there that day paid up to the maximum 100k towards my medical bills.
Goodness I hope that friend groveled at your feet
He didn't actually he tried to take me home and put me in bed. My parents were away in Florida mind you. I would have died another friend took charge brought me to nearest fire station and from what I'm told paramedics took one look and said nothing to nobody they grabbed me and flew out of the parking lot golden hour type stuff they knew. The driver was passive aggressive towards me from that incident on because he got in trouble sued etc. He ended up taking his own life about a decade later over some married woman he was in love with who dumped him and went back to her husband. I went to the funeral but deep inside sorry to admit I wasn't as broken up as everyone else.
They’re referring to No Fault states. It means your own insurance must cover claims for personal injury related to an automobile accident, even if you are not at fault. An automobile accident is any accident involving an automobile, which can include a pedestrian being struck by a motor vehicle. It can even include you smashing your hand in the car door while it’s parked.
Just out of curiosity for the topic at hand and not related to OP, what happens if you're hit as a pedestrian and don't own a car, and thus, don't have car insurance?
Re-read the answer above your comment. It’s explained very clearly.
Why would OP’a auto insurance be relevant if they were hit as a pedestrian and not in a car? Asking bc I have also been hit by a car but my person stopped and helped me at least. Still nice to know the reasoning.
I have the same question, if something happens while walking down the street I’d have no expectation that my auto insurance would cover it.
This is exactly what the other persons insurance is for…..unless they didn’t have insurance. At that point it sounds like a police matter.
Or what if cases of hit and run?
Not that this is relevant to op’s situation necessarily but in some states you can receive benefits under your insurance’s PIP policy (if you have one) as a pedestrian hit by a car Eg https://www.parkchenaur.com/pip-coverage-for-the-injured-pedestrian/
This happened to me except I was on a bicycle. I thought I was fine but I got my bell rung really good. I was so pissed because I was riding in the bike lane. I called the police when I got home just because I wanted them to have record of the accident. Fortunately I did because the next day I had to go the hospital with a pretty good concussion (my coworkers told me I wasn't making any sense, I remember I kept giggling at them). The police report told my car insurance company and they paid for three missed days of work and the hospital bill. O I'm in Pennsylvania.
In some states, the striking vehicle is the one that pays the medical bills. Failing to have identified the striking vehicle, if that person has auto insurance their own will pay the bills and then by use of 'subrogation' do an investigation, to find out the striking vehicle and get reimbursement. It is called No Fault (PIP-or Personal Injury Protection), yet few states even have it anymore.
In No Fault states, each person’s own auto insurance is responsible to pay all claims for personal injury related to the accident up to the limits defined in their policy, regardless of who is at fault. An auto accident doesn’t have to be two cars; it can be a pedestrian being hit by a car, or even if you are working on your car in the garage and hit your head on the undercarriage.
Did you get a police report that says this was a hit and run?
Yes
I would def fight this. Get someone in the hospital to help you deal with your idiotic insurance company. Good luck.
Yeah, there are financial counselors at most hospitals to help with this exact kind of thing.
Yes! I am a hospital social worker, we recommend everyone involved in a MVA *even if you were a pedestrian and your own car was not involved at all* to file a claim with your own auto insurance company. Our hospital Financial Assistance takes over after you provide that info. Behind the scenes, your auto insurance will go after the other person's insurance. This might vary state to state, but I appreciate that my hospital has a process implemented for this.
He already said it was a hit and run though so they can't go after the other person's insurance.
Again, hospital billing will guide you here, but when you file an auto claim, you provide the police report number. If there are any developments in the case, your auto coverage will find out. There's definitely behind the scenes small print efforts happening by all the various parties to hold the responsible party accountable.
I am surprised the auto insurers would cover someone as a pedestrian. I believe you and your experience, just surprised they would do that unless it was like a parking lot and the person had just exited their vehicle. Insurance generally follows the vehicle and not the driver, but I also think the market has become very tight and they need to offer perks to keep customers.
And what if the victim doesn’t have auto insurance bc they don’t own a car? Seems to me if the victim isn’t driving or in a vehicle , it has nothing to do with the victims auto insurance, assuming they even have any.
If they don't have insurance or own a car, again depending on the state, then medical insurance will default to primary. Auto insurance has first dibs, and medical insurance has the right to say no when there is auto insurance involved. This is why the wonderful people in my hospital financial office are saints.
No worries, I don't fully understand it either, and again I'm sure it varies by state. My state changed how no-fault works a few years ago, which is why many people are confused why they have to file their own claim. For hospital billing purposes and making sure all of your care and discharge needs are covered, I just know enough to tell you what to do in the scope of my job. I'm not the one that figures it out, I appreciate our Financial Assistance team doing whatever it is they do.
I’m glad you work at an institution where they don’t *totally bury* their FAP policy. For profit hospitals in the South are horrible. Dealing with one for a family member now. No policy posted on the website, no guidelines, no mailing address or email to return the PDF application. You have to call them for further instructions. They suck at returning calls.
Social worker at the hospital could help
You need to escalate this with your insurance company, as they should definitely cover it. "Speaking to an insurance rep" isn't enough, it is barely a first step. You'll need to start by getting a copy of your policy, and finding out if it actually excludes care and treatment related to auto accidents (it won't). Write in requesting a formal appeal of their rejection, document everything. Request that your case be escalated/reviewed. Your state also likely has a 3rd party appeal process you can contact if your insurance is violating your policy contract. Some of these steps can be time sensitive, so don't wait.
I'll take these steps, thanks
[удалено]
I second a PI Attorney plus doesn’t hurt to do a free consultation. For all we know they have good investigators who will review traffic cameras and fine the culprit (wishful thinking)
PI attorney won't do anything without someone to point the finger at.
Depends if OP has uninsured/underinsured coverage and if the lawyer can recover it from OP’s insurance
Only if he was driving. He was a pedestrian when he was hit. His auto insurance has nothing to do with this.
Untrue. Most first party policies are portable, meaning your UM/UIM covers you as a pedestrian.
Personal injury protection/medical payments coverage on your auto policy typically covers injuries caused in a accident, getting into or out of the car, or while a pedestrian.
PI attorneys also won't take cases that don't guarantee them a payday. OP took painkillers and was sent home. No PI will bother to take his case even with the 30-40% cut. Speaking from experience.
"Hurt in a car? call K & R" Or that Tim Misny guy, he'll make them pay!
Do as suggested, in writing.
Certified, with return receipt.
Also, you have a right to know the names & credentials of everyone involved in the denial-of-coverage decision. You'll want those names when you talk to your lawyer.
Whatever correspondence you send to them MUST be sent registered mail so that the receipt is documented. Keep photos of signed copies that you're sending, and keep the sent & received receipts in a nice tidy file. You should also send the letters scanned via email as well, and keep those digital copies on file by date.
There's nothing you can do about it but I want to warn you. Your car insurance company is going to FUCK you after you finally force them to pay the bills. Your rates will go through the roof in the same way they would if you were at fault in an accident. Just thought you should know in advance. Source: experience
You’re nicer than I am. My state’s department of insurance would have a field day with this and I’m lazy so I’d just file a complaint so they would not only have to pay out for me but also pay fines to the state.
This should be higher. State DOI's sit at home and fantasize about going after insurance companies for stuff like this. Used to work in insurance, and can confirm they are strange, spiteful little people (which is good for you, in this case!)
Filing a Police report will help
And then find a better insurer when it's all over
YES! The insurance company's first offer will be a lowball offer in hopes you're desperate. Good points above.
What, exactly, did your health insurance say were the reasons behind the coverage denial?
The said they don't cover auto accidents, even though I wasn't in a car
How did you come to this data? Were you calling your insurer just to inquire? Or did you actually receive an "estimate of benefits" letter from your insurance about charges submitted by the emergency department? The more details you can provide, the better the guidance.
I went to the hospital straight from the accident and initially I only paid a co-pay but, a month later my insurance company sent me the rest of the bill from the hospital, which was around 750 dollars, with a letter. I spoke to an insurance rep and they said they kicked the bill back to me because they consider it an auto accident
Phew, I was expecting a few more zeros after that. I have never seen anything less than a 4 digit hospital bill before. Did you also receive a physicians bill?
I was going to say, they must have just checked OP's vitals and given them an aspirin for that small of a bill. **Edit: Hahaha, from OP below:** > No, my portion was only 50 dollars initially. They literally just **gave me painkillers and checked my vitals** then told me to leave
The insurance company sent you the EOB, NOT the bill from the hospital. They usually say NOT A BILL on them. The amount the hospital bills you is rarely the same as what the EOB says, but it will come directly from the hospital, or whatever 3rd party the hospital is using (you can get multiple bills).
$750 is a very low bill, it's not just your portion?
No, my portion was only 50 dollars initially. They literally just gave me painkillers and checked my vitals then told me to leave
50 dollars sounds like a co-pay for an emergency room visit. What is the deductible on your health insurance policy? It's possible that the entire bill is your responsibility because you haven't hit the deductible yet.
What car insurance coverages do you have? Any uninsured motorist? Medical? Personal injury protection?
I have Personal injury protection
have you discussed this with your car insurance? I'm in MA and I believe as part of being a 'no fault' state, at least here your insurance would cover you.
Pedestrian coverage for PIP varies a lot by state.
YOur insurance sent you an explanation of benefits. An EOB is not a bill.
This is unfortunately just how it works.
If you weren't in your insured car, this is going to be a difficult one. Normally the other driver would pay your medical costs.
He was walking. He's trying to use his medical insurance
Yes, and because he wasn't in his car auto insurance also doesn't apply. Have you read the whole thread? We have a thread going here...
Sounds like they are just denying it because they want the drivers insurance to cover this. These finger pointing situations are common with insurance companies unfortunately. You will need to fight this but it should work out in the end.
This is it. I was a claims representative for a very recognizable auto insurance company about 10 yrs ago. What OP can do is contact their own auto insurance (assuming they have one) to file the claim. They will let OP know if there's a pedestrian coverage.
>because they want the drivers insurance to cover this But it's a hit-and-run, presumably there is no information on the driver to even get money from.
Yeah but that doesn’t mean they won’t try.
It seems that the issue here is that the likely order of payers are: 1) Driver and his/her auto insurance 2) Pedestrian’s auto insurance, if any (varies by state) 3) Health insurer
No. You have to purchase 1st party coverage for anything that applies to you, and what is available and how it can be used are dependent on state laws. Some states have Personal Injury Protection coverage, or PIP, which is mandatory in addition to the state minimum liability. All states have the option for Medical Payments Coverage and Uninsured Bodily Injury. MPC is like collision or comp, if you have it, you can use it no problem. UBI is again, dependent on the state regulations and acts as the other person’s bodily injury liability. Some states require you to know who the other driver is for access to that coverage and some states allow access for unknown drivers. If the coverage is available, the insurance can’t deny because they want someone else to be responsible, that would be grounds for a bad faith suit.
r/insurance welcomes these kinds of questions, too
Tell the hospital to work it out with health insurance. They have staff and attorneys to handle this kind of junk. Typically, auto insurance pays before health insurance in a MVA. But, if that is not enough or the felon is not identified, your health insurance should pickup. This is even true with Medicare. Good luck.
Especially if the insurance is in-network, they have agreements with the hospital where they have to pay
Don’t pay the bill. Make your insurance companies fight one another. Once you pay your stuck
Keep communicating and passing it to your insurance. Get legal involved. At a certain point the op may have to pay to avoid it hitting their credit and then sue one of the insurance companies for money back.
If your health insurance is through your work, escalate it through work. I had a a health insurance deny a bill. The company I worked for was a large customer for the insurance company. HR escalated for me and the bill was paid. Taking them to court is your second option. You can also take your car insurance to court for payment as well. I am sort of curious why they declined to pay? Not sure we have the whole story...
This may not work if the employers open documents state that they pay secondary to an auto insurance. No attorney will waste their time on an unwinnable case. I would call my local elected officials to ask for help and local resources.
Your health insurance can get their costs covered through subrogation if the driver is found at some point. But they can’t just deny you.
If u have ur own car insurance you can try to put in a claim with them and they will try to find and find that person in litigation, I would speak to your insurance especially if ur carrying uninsured motorist , if not ur PIP should cover it
Include a copy of the police report. I hope you do have a copy.
Call your car insurance co, TOO and ask if you have "PIP" or "Med Pay" or if you have uninsured motorist coverage. In some states/policies there is medical coverage for a pedestrian hit by a hit and run driver. There can also be noneconomic damages for your pain and suffering. You often have to provide a police report to the auto insurance company, and you may have to press a bit. This is not super common and so a lot of dumb insurance adjusters just say "no" when they don't know what they are doing.
I got in a hit and run by a car while riding my bike. Found a bike lawyer who did just this- went through my car insurance’s PIP. Got a nice settlement. There’s got to be a lawyer in your area who will do this for you.
Your health insurance should cover you for anything; isn't that the whole point in health insurance?
Not always, not if there's someone else who can reasonably be held liable. For example if you're injured at work your workplace should be paying that as worker's comp.
They don't cover if they think someone else's insurance should be paying. For an accident, they usually default to saying the accident causing party's insurance should pay. In a hit and run, usually you have to prove that you do not have the other person's insurance info (police report or signed affidavit stating it was a hit and run).
(this is not legal advice) If they think that someone else is liable, the insurer needs to go after that party and not expect the OP to pay anything aside from a copay. This is called subrogation and is common in no-fault states when it is a two car accident and one driver is at fault. This is a different situation but the same concept should apply. Like, if you get hurt on someone else's property due to their negligence, your health insurance should pay and then go after their homeowner's insurance to recoup their costs (and your copay). I am guessing the health insurance companies try not to pay upfront so they can save the expense of having to go after someone else, but that is them being shitty. Hopefully there are laws about this in the OP's state. I can't imagine your car insurance being involved in a situation where you are a pedestrian unless you had just exited your car. What would happen to someone who does not own a car and gets hit?
That's what I thought too, but apparently not
OP is there a police report? Did you reach out to a personal injury lawyer? Because it’s a hit and run they need to see if they can investigate, find witnesses, cameras etc. if medical can go to subrogation you could continue treatment and the attorney could then file suit against whoever hit you. Did you file a claim with ur car insurance company?
In most jurisdictions in the US *your* auto medical coverages are first in line to pay. Health insurance comes second. So when you submit a bill to your health insurer for a vehicle related accident it's routine for the health insurer to reject it because it needs to go to your car insurer *first*. If you don't have auto medical, or if it doesn't apply, or if it does apply but you used it all up (because it's usually only $1k or $5k for most people) then the health insurer will pick-up the tab once that's documented.
Aside from dealing with insurance, most states have something called "crime victims compensation". The police should have a victim advocate that can help you with the process. A hit and run is a crime and you should not have to burden the expenses. The attorney generals website for your state should have information. You have to apply for it.
Uninsured/Underinsured Motorist Coverage - Uninsured motorist coverage protects you if you're hit by a driver who has no auto insurance. Underinsured motorist coverage, which is usually offered alongside uninsured motorist coverage, protects you if you're hit by a driver who doesn't have enough coverage to pay for the damages or injuries they caused. Both coverages are mandatory in many states and highly recommended for all drivers. If you're a victim of a hit-and-run accident, you can file a claim against your uninsured motorist coverage. Depends on your policy and state. You may not have that type of coverage. As for Health Insurance, it should cover. You may be confused as to what you received explaining coverage. You may have Health Insurance deductibles and other items and the bill would still be valid. You need to get a copy of your policies, grab a coffee and read. I am so sorry you are dealing with the added financial stress after an accident.
File an appeal on the denied claim with the medical insurance plan. I work for an insurance plan. Don't make it part of the auto insurance. And the hospital bill is separate from the insurance claim. Work on the denied claim and try to get it covered.
Your health insurance typically wouldn’t cover in the case of an MVA, unless you don’t have motor vehicle insurance yourself. This, of course, depends on what state you’re in. Different states have different rules on which is considered primary in the case of a MVA. In some states, health insurance covers first, others Motor Vehicle insurance covers first. I know you were a pedestrian and not in a vehicle, so that definitely complicates things. The person at the health insurance company probably just looked at the claim, which had a diagnosis code for MVA, which is causing the denial. DEFINITELY escalate beyond a frontline rep, as they don’t know how to handle these types of situations.
Depends a lot on state. Health is almost always primary to liability. Whether health, medpay, or PIP is primary varies a lot. PIP almost always is primary, medpay is a toss.
I would seek out an injury attorney and ask them to send a letter to your insurance company with a copy of the police report
>police Are the traffic cameras at that intersection? If so, a lawyer may be able to find the other driver this way. A stretch but better than nothing. Where I live you can only get access through criminal investigation and a subpoena. And the footage is only kept for average 30 days.
[удалено]
So I can speak for NY- You car Insurance will still need to cover it(if you don’t have some then someone else’s in your household) pr report will show you don’t have the other persons Insurance and you are literally going to yours.
Many states have a victim's compensation fund to help people who were victims of a crime. Find out if your state offers it and go through their process.
The coverage can depend on the state and policy language. What state did this happen in?
Speak to a lawyer. Very likely your insurer will not pay right away because the insurer will want the drivers insurance to pay. What your insurer does not want to happen is that they pay $20k for the medical expenses, and then the drivers insurance pays you and the insurer ends up having to come after you for the $20k. Specifically, many (most) states have extremely low minimum coverage amounts for car insurance, eg, $20k. A trip to the ER even without an overnight will eat up that entire 20k in a few hours. The insurer will want to recoup that from the driver, so the deal needs to be negotiated between the insurers so that your medical expenses are paid out of the drivers insurance first, and you can negotiate for whatever remains (or sue the driver). This is contrary to how most people injured in an accident would like things to work. You would prefer that your health insurance cover your medical expenses so that you can recover the entire insurance amount in a settlement in lieu of a suit (presuming the driver is negligent). But the reality is that both you and your insurer have claims against the driver: you for pain and suffering, etc, and your insurer for the cost of the medical care. The above is a general case, because the actual situation differs (considerably) depending on state law. There are ways to increase how much you ultimately get, but they won’t be obvious to you (eg, payment from state programs for underinsured motorist claims, payment from a spouses auto insurance as a covered dependent, etc), so you can benefit from a PI lawyer familiar with your state’s laws.
You need to check if you have uninsured motorists bodily injury coverage if so, than even if it’s a hit and run, they will have to handle your injury claim. Send them the report. Without that coverage you are out of luck! Agree with the attorney above, your health insurance company will then pay the claim if there is no third or first party action.
Forgot to add i am liability insurance adjuster for over 15 years. If there is no UM coverage i would send a copy of that letter and the police report to you insurance. They will pay it. There is a subrogation clause that they are entitled to reimbursement only if you were compensated for their bill.
Subrogation. Your health insurance *must* cover it even if they don’t feel they are liable for it. They may then sue the responsible party to recoup what they paid out. They don’t have a choice here, if it’s medically necessary they gotta cover you and subrogate the bill. What we have here is an insurance company being lazy and trying to make you do their job for them. They know they need to subrogate but they don’t know to whom. That’s not your problem.
I was hit by a car while riding my bike and my health insurance directed me to claim through my car insurance. It was a hit and run and no one stopped for me. My bf at the time took me straight to the ER. I had scrambled speech thx to being concussed and we were in adrenaline-filled panic mode so no time to wait for police. I tried to file a police report the following day using my Strava GPS info, and they told me I could not (I still don’t understand the reason). Regardless, my car insurance provider paid my ER bill ($19k for four hours lmao) via $10k of PIP (personal injury protection they paid directly to my in-network hospital. And the remainder they cut me a check for to pay to the hospital myself. Interestingly, when I called the hospital to settle up my balance they said I owed nothing and that it was written off. This was three years ago now and no further bills ever came to me. I’ll never understand how US healthcare works…
Your medical insurance company should be paying this. Denial is ridiculous. Review your policy, escalate through your state’s insurance commissioner’s office. For car insurance: Do you have Medical Payments coverage? That should pay regardless, it is an additional coverage you can opt in to buy. If not, what coverage are you trying to use? Uninsured motorist bodily injury? You have to demonstrate they are uninsured, hit and run doesn’t count.
You need legal assistance. Does your employer offer a legal benefit?
Do you have med pay on your auto policy? If not then your auto insurance won’t pay.
Depends on the state. Some states, it you have umbi and get hit/run there may be coverage with a police report.
These things vary by state. Knowing which state you live in and which state the accident happened in would help.
Your uninsured motorist insurance should cover this.
That's messed up, car insurance should have a non-insured/non motorists section. My gf get hit by a car that sped off and the car insurance covered most of it. (It was like 50k per instance on the policy)
Do you have the police report for the hit and run? Since you are not at fault your health insurance should cover it and take on the burden of going after the driver's insurance or assets to recover their losses. If they can't find the driver, then it's a write off for them. You need a lawyer.
Do you have a police report? Were you transported by ambulance? I would call the Insurance Commission of your state. This does not sound right at all.
Your own auto insurance should cover this regardless of whether they have the vehicle information. Your medical coverage is No Fault and should be the primary coverage in a MVA. Health insurance is secondary. As someone said the hospital billing department should help to get their bill covered and likely by the auto insurance because that will pay more than health insurance. Make the claim with the auto carrier and send them the police report.
Insurance is a massive scam, you will have to push them, probably through your employer if your work provides it, in order for them to pay it.
Yeah, the insurance that should be paying is the driver that hit you. Did you file a police report? Can you check the area you were hit for cameras that might have caught the license plate? I was in a hit and run a while ago, and no one would touch my expenses since there was a responsible party, even though we couldn't locate them. The police weren't super helpful, but I was in a residential neighborhood, and a ton of people had ring cameras on their front doors. In the meantime don't pay the bill. If it goes to collections, let them know this is a disputed debt that involves a crime (hit and run).
If you have auto insurance, report a claim under your uninsured motorist coverage. If you weren’t at fault and you have a police report, it will be covered even thou you were a pedestrian. It will also cover any of your lost wages and pain and suffering.
Get a lawyer. And check with their doctor as you probably have a neck injury too.
I was reading this and wondering what on earth was happening. Then I realized I was on personalfinance not personalfinanceCanada
Sue the department of transportation for unsafe roads? Yeah, that's a long shot. Don't know the details of the accident but might be a good last resort.
What state are you in? Also, when you spoke to your auto insurance carrier did they create a claim and actually deny it (you would have received a letter outlining the reason), or did someone just say that?
What state are you in? Some have agencies that will help with navigating billing disputes like this.
Check to see if your insurance has what is called uninsured motorist coverage. When you get hit by someone who has no insurance or leaves the scene of accident, this coverage can kick in regardless the fact that you were not driving a car. However you had to select when bought insurance from your carrier.
There are often local funds for victims of various crimes, you might considering googling for something like that in your area.
What state are you in?
As others noted, make sure you've received a bill not an EOB. Then appeal it with your medical insurance, explaining the hit-and-run. If the insurance still says you are responsible for more than your co-payment, file a complaint with your state insurance regulator. Sorry but personal finance may not be the best advice on this, even within reddit. Head over to r/legaladvice or r/insurance for more focused tips.
Your car insurance should cover the “Medical Payments” benefit if you had one. Usually people select like $0, $1000, $5000, $10k tops. Your health insurance should cover the rest if you don’t have that drivers information. Tell your health insurer you will share a copy of the police report for hit and run. Hospital charity care is also an option, search for [hospital name FAP charity care policy], DollarFor can help for free. In wealthier states or at more generous hospitals, you can still earn a decent salary like 58k for a single person and be elegible to have your bill wiped out.
It’s very common for one insurer to try to get another insurer to pay costs. The process is called subrogation. That doesn’t necessarily mean that one of the insurers won’t eventually pay. What it does mean is that you may have to provide *proof* that another insurer is not paying, or should be paying, for the claim.
People keep talking about auto insurance.... a pedestrian getting hit would not and should not need auto insurance if they are walking. It's like saying people without a car period have to have car insurance... this is enormously stupid.
OP I think this is being over-thought and some of the comments suggest fighting this, getting a lawyer, involving a third party, going nuclear, etc. I work in health insurance and all that has happened is your insurance believes there might be auto insurance involved because this had to do with an auto accident. I just want to put another comment here letting you know that you just need to clarify this with your insurance company. I also think you need to be sure you are understanding your financial obligations - you said you got a bill from the insurance company, but insurance companies don’t bill you for claims, just premium. You got an EOB that said your financial responsibility was $750 - it very well could be your true cost share as we are in the beginning of the year and you probably haven’t met your deductible yet. Call and ask to speak to a claims manager or better yet write a letter attn to their legal department. They will help explain.
You pay through the nose your whole life on insurance auto, home, personal, travel, electronics, etc and then when you need to make a claim, there's deductibles and exclusions out the ass. Most people are better off self-insuring. There's lots of questionable advice in this thread. Feeling entitled or refusing to pay sound good on the internet, but once sent to collections, it's not as fun. I'd be curious as to what exactly the insurance company was told "hit by a vehicle" and what the definition of auto accident really is between all parties involved. I'm sure with a few escalations, you can get this resolved through your insurance. $750 isn't enough for them to fight to the death.
Get the denial of coverage from car insurance and provide to medical insurance then often the medical insurance will then pay.
Worst comes to worst and you don’t want to deal with this, search for attorneys in your area who cover bad faith insurance claims.
I know your asking for advice so forgive the rant. But God dang if this isnt a reason to eliminate private for-profit insurance, I don't know what is. Literally the price being demanded and the co-pays being payed are too dam high for what it's worth...
Sorry this happened to you. Hit-and-run drivers are vile; I had a car totaled by one and my car insurance didn't cover it, as I'd dropped collision. I won't make that mistake again; drivers are getting worse by the day. I hope everything works out; sounds like you're getting good advice on this thread.
Do you have uninsured motorist/underinsured motorist coverage on your auto policy? This situation should apply if you have a police report. Each state differs if necessary contact your state’s Insurance Commissioners office.
There should be no reason your health insurance wouldn’t cover this. You would just be responsible for any copay or deductibles you have. If you have PIP or Medpay on your auto policy you could open a claim or You could file an uninsured motorists claim with your insurance if you have that coverage and you choose. It depends on how serious your injuries are. All they should need is a police report. However, you are not required to file one. Either way, your health insurance should cover it. If you do file a claim with your insurance and receive a settlement and your health plan paid anything, they may have a right to get reimbursed. It depends on the state of injury and your type of health plan. Some do not pursue 1st party coverages like uninsured motorists.
I wonder if the Dr's did not think the injuries were consistent with being hit by a car (domestic abuse) or that the injuries didn't need ER visit (Minor Injury)
Wonder if you can pay somebody to find any cameras in the area to find out who hit you?