Does health insurance pick up unpaid costs after auto insurance in Ohio?

by Sarah
(Columbus, Ohio)

I was hit by an uninsured motorist in August of 2007. I was taken to the emergency room and treated. Since the accident, the hospital billed my health insurance and my health insurance paid out on the bills and then realized it was related to an auto accident. Now my health insurance wants the money back. First of all, I did not ask the hospital to bill my health insurance since it was an auto accident and the other driver was at fault (he ran a red light). So I am trying to go through my auto insurance where I have full coverage, but my medical pay out is for $ 5000 which does not cover all of the bills. Now I am stuck in a battle between my auto insurance- USAA, and my health insurance-Aetna, who both say the other is responsible for paying my medical bills. USAA claims that in Ohio there is a law stating the auto victim has the right to designate health insurance as the primary party for billing. However, Aetna claims they don't have to pay anything since someone else is at fault and its an auto accident. I am so confused and am paying out of pocket for all of these bills and am facing collections since I don't earn enough to pay all of the bills to begin with. Plus I have no idea if my auto insurance has done anything to go after the person who hit me. USAA keeps changing the people handling my claim and each time things get more screwed up and I am unable to get anything accomplished or settled. Also, I still have serious injuries from the accident and am unable to get treatment since I don't have money for the bills. I am going to need surgery on my left shoulder which is expensive and requires physical therapy and also I will be unable to work during recovery. I have constant pain in my shoulder and back and this is getting worse as time goes by. If my health insurance won't cover any of this I am screwed. I have full health coverage and should be able to get treatment but they refuse to pay for anything related to the auto accident. WHat are my rights and what can I do. I am losing my mind. I haven't slept at all over this last week because of the pain and stress. I need help figuring this out.

Answer

Wow, Sorry to hear about your situation. Well, I cannot give you an specific answer because I am unsure how Ohio will handle this situation. You really need consult with an attorney on this one.

With that being said, I will give you what we believe is the "normal" rule leaving up to you to double check on Ohio rules.

Usually your auto policy is always your first place for coverage. Your PIP and/or Med pay apply regardless of fault or anything else (as long as you have the coverage and that you are in a car accident). After that coverage is exhausted, your medical health insurance policy should kick in and act as an excess to the limits of the first policy.

Remember, this is the general rule. However, the actual policies will tell you how this type of situation will be handled. You need to be looking at the other insurance clause, or the financially responsible clause. You need to read both polices to be able to make a decision.

If the health insurance paid, and the auto policy should have paid, it is possible that the auto policy must render payment to the health insurance company. It all depends on the policies.

The bottom line is this. You should contact the office of the insurance commissioner or the department of insurance and have the two insurance companies come to terms. Report them both and let them figure it out. Before you do anything, talk to an attorney.

Good Luck.