What is “billed verses paid,” and why should I care?

People who seek medical treatment after an accident from a motor vehicle collision, a slip and fall, or some other misfortune causing injury, will quickly realize that insurance companies attempt to reduce their responsibility under a theory known as “Billed versus Paid.”

In a nutshell, “Billed vs. Paid” boils down to the amount a medical provider accepts for services rendered, verses the amount they billed for that service.

For example, a hospital may bill $1,000 for a trip to the emergency room, but it may accept far less based on negotiated contracts. Under “Bill vs. Paid,” the insurance company for the person who caused the injury will only compensate you for the amount actually paid by your health insurance company (which may have the right to get that payment back from you).

On the surface, this seems somewhat equitable– why should a person be entitled to the billed rate if their health insurance only paid a percentage of that rate?

Let’s ask the question another way: would this seem equitable if a jury based its overall valuation of an injury on the amount of the medical bills actually paid?

For the exact same injury, a person with health insurance would have much less to show in bills than a person without insurance. In that situation, the person without health insurance stands in a much better position in front of a jury if it awards some multiplier of the bills.

“Billed vs. Paid” gives the insurance company the ability to use your health coverage against you without paying you anything in return.

Does this still sound equitable?

If you have questions about the way an insurance company is treating you, or if you have general questions about a no-fault injury, and want answers about your options, call the personal injury attorneys at Bryan & Terrill Law, 918-935-2777.