In this podcast episode, Josh and Aaron talk through medical bills after a car wreck and what options are available for people that don’t have health insurance. A recent Texas Supreme Court decision, In re Allstate, has made taking care of medical bills after a car accident injury more difficult, so tune in to learn what’s changed and what you need to know.
Listen here or read the transcript below. FVF’s Summary Judgment podcast is available wherever you listen to podcasts including Apple Podcasts, Spotify, iHeart Radio, and more.
Intro: Thank you for tuning into Summary Judgment where Austin personal injury attorneys, Josh Fogelman and Aaron Von Flatern of FVF Law, discuss the ins, outs, and in-betweens of personal injury cases.
Josh Fogelman: Welcome back to Summary Judgment and thanks for tuning in. I’m Josh Fogelman and I’m here with my co-founder and partner, Aaron Von Flatern. Today, we want to talk about what options are available for people who don’t have health insurance to get medical treatment after they have been hurt in a car wreck or another injury causing event. Aaron, I know that the law in this area is a little bit complicated, and it’s gotten even more complicated in light of a recent Supreme Court decision In re Allstate. What’s going on in the law with this?
Aaron Von Flatern: Yes, this topic is just an excuse for us to talk about this new case from the Texas Supreme Court. It has torpedoed some of the options that a lot of injured parties have and at least made it more difficult, and that’s why we wanted it to have an informal, unstructured conversation about it because it’s tricky. In the past, if someone didn’t have health insurance, their best option would be to sort of broker a deal with the medical providers, if they have, to essentially treat on credit and then hopefully be able to pay those providers out of the eventual settlement of the case, and the providers would get on board with that pretty quickly, some of them would, because what they could do in that situation is charge something closer to their sticker price. We all know when you get a medical bill, it comes in at $300, they send it into the health insurance company, and it gets reduced down to $70 dollars, right?
Well, in this treating on credit situation, a lot of times the bill would end up being like around 150, so it’s more than what the adjusted health insurance price is, not quite the regular sticker price, and that would make the doctors happy, they had to wait on their money, but just like a bank that charges interest, they’re just going to charge a little more, and they make up for it, and they take that risk and they’re happy, and they’re fine. And that’s how you would do it if you didn’t have health insurance. Now the Texas Supreme Court has handed down this In re Allstate case, which has made the way you prove up medical bills a little trickier and has made it a lot more likely that the jury can only see that health insurance rate. That means all settlements are predictions of what happens in trial, and that means that when you go to settle the case, you’re settling in on that insurance rate.
Now, if that’s true, that means the settlement’s going to be smaller, it also means your ability to pay that doctor out of a settlement, which not all settlements are great, a lot of them are, some of them are compromises. And so if you’re in that compromise state, it gets difficult to pay the doctor what the doctor really wants, and that means ultimately that the doctors are less willing to enter into this deal. Josh, I’ll let you take it from there as to what that practically means.
Josh Fogelman: Yeah, like you said, Aaron, the problem that we’re dealing with here is you have a select group of medical providers who understand the business of how they can go about contributing to the community by offering health care on credit and taking that risk of not only delayed payment but in some, and many instances, non-payment at all, but taking that risk in being there as a network to provide medical care to those people who, through no fault of their own, find themselves in need of medical treatment and either completely without the financial resources to secure that medical treatment like no health insurance, or even those people who have health insurance but might be financially burdened by things like co-pays and deductibles, didn’t have to worry about that financial burden, you could focus on getting the care that they needed in order to get better and get back to work and start putting their lives back together.
And for years, the courts have struggled with how do we account for the fact that medical providers and just the way that our medical system works as a whole in America, medical providers charge a lot of money, but then they negotiate these contracts with the big health insurance providers, Blue Cross, Blue Shield, United Healthcare, where instead of getting paid what they charge, they accept a pretty huge reduction, like you mentioned, Aaron, in order to guarantee prompt payment to clients, they take less money, but they get paid on time, they had access to the whole network of those insurance companies, patients are insured, so there’s benefit there. And so the way that the businesses have developed in the letter of protection is, what we call it, when a medical provider provides treatment on credit to a car crash victim or another accident victim, they learned how to account for those risks and then balance it and be able to make a viable business out of it.
Now, with what happened In re Allstate is, we used to have this really simple way, the claimants who were hurt used to have this really efficient way to prove that the medical care that they had received as a result of an accident was both necessary and that the charges that they had incurred for those medical bills were reasonable, and the legislature actually provided this tool for the court system as a whole, because it dramatically lessened the amount of fighting that went on and the burden on the doctors by letting you prove up those medical bills with the simple affidavit filled out by the doctor’s office, instead of having to bring the doctor away from treating patients and depose them or schedule a trial around the doctors’ availability. And, effectively, what In re Allstate did is gutted that statute. They basically really created an opportunity for auto insurance companies who are unhappy with the amount of victims’ medical expenses to create enough procedural headache to make it very difficult for the letter of protection-based business to continue to be viable in Texas, which is a real problem for those people who can’t afford to get the health care on their own.
Aaron Von Flatern: What’s the solution? How are we going to cope with that? How are injured parties supposed to cope with that, if they don’t have health insurance here in Texas?
Josh Fogelman: Well, that’s a good question. I don’t expect these businesses to go out of business, but I do think that access to those types of medical clinics and medical facilities is going to become more restrict, and I think some of them will grow out of business and you’ll see less and less of them, but a huge part of any reputable personal injury attorneys… The practice is not just going to be focusing on the medical expenses that are incurred in the case. When we look at a case, the medical bills are a very small part of it in many, many, many instances. What really matters to us and where we add value to a client’s file is by helping understand what the client has lost beyond medical expenses, things like the physical impairment and changes in their quality of life, what their future medical expenses are likely to be as a result of their injury, and we focus on the case as a whole, the bigger picture of the case, and really try to quantify what those losses are in a meaningful way.
We’ve had a lot of success doing that in front of juries, and so we know how to handle a case even if the medical expenses are really small, or even if we end up having to have a big fight with the auto insurance company about whether or not the medical expenses that our client has incurred are reasonable or for necessary medical expenses.
Aaron Von Flatern: If I could summarize that, I would boil that down to the answer to the solution is, part one is good clients and part two is good lawyers. We’ve had a lot of… I take it as a huge compliment when doctors tell us that they really like our clients. Clients who have real injuries, they have a reason to be in court, they are likeable, credible, normal people, not this idea of some super litigious person, but just a regular person dealing with some really unfortunate and preventable circumstances, standing in court and asking for what’s due under the law, that is the kind of client you want now, and you also have to have good lawyers who know how to build the case properly, how to put the scaffolding on it, and not just rely on the amount of the medical bills to get you there. Because I think that was… I hate to say there are bad lawyers out there, but we all know that there is some bad lawyering, and the bad lawyering is where you just take your medical bills into court and you hope the jury’s going to give you some multiple of that, and that’s just like winging on a prayer.
Whereas what I’d like to think we do is really examine all of the harms and losses that a person has gone through, really sink our teeth into it and understand it deeply, wear it on our sleeve, argue with emotional force for the jury to respond to it, and when you do that repeatedly with good clients and good lawyers, you end up with really good results, both in trial and in mediation. And when you keep getting good results then the doctors are a lot more willing to say, “You know what, I’ll take a chance on this person. I’ll treat them on credit. I might not get paid for two years, but I’m going to do it because I know this firm, and I believe they have good clients who are going to have good results.” And so it’s a partnership when you get into a relationship with a personal injury lawyer, and so it’s about picking good partners.
Josh Fogelman: Yeah, that’s absolutely right. One of the reasons why things have gotten out of hand where the Supreme Court felt the need to intervene in the Texas legislature almost intervene is because there is a lot of abuse, like in any industry, there’s been a lot of abuse by bad acting doctors and some bad acting lawyers that allow things to get out of hand. And so there’s been a correction here now, whether it’s gone too far is sort of to be seen. If it impairs a person’s ability to have access to medical care, then that’s the bigger problem. But, Aaron, to your point, part of the decision-making process if you’ve been hurt by somebody else is getting informed, getting educated, understanding what your rights and options are, and you want to do that with a lawyer who’s credible, who has a good reputation in their community, and who isn’t going to take advantage of the healthcare system, let alone you. So being careful about who you’re associating with and being thoughtful about who you choose to get advice from, those are going to carry you a long way if you’re in the unfortunate position of having to look for an attorney.
Aaron Von Flatern: Very well said. And this has been another episode of Summary Judgment, we hope you enjoy it, we certainly did, and this has been a great conversation with you, Josh. We will return next time with another fun topic.