Does the insurance have to pay?

-ok soo i was involved in an accident that wasnt my fault and i ended up dislocating my elbow. Soo i go to therapy 3 times a week and my health insurance is paying it so far but are going to stop in a couple of visits. Soo the doctor told me i need 8 more weeks of therapy and the health insurance company is not going to end up paying those full 8 weeks. i told the car insurance company and they said that i have to pay it then they will remburst me for the money i paid. The problem is that i cant afford what the therapy is asking and i dont know what to do. What should i do? and also dont tell me stop going to therapy because i need it very much as my arm is only 18 degrees extension. THANKS!!!Critical point here . . . WHOSE insurance are you talking about?? YOUR medical payments or pip coverage, will pay out as you go. The OTHER guy's liability insurance, cannot be billed - they'll "settle" at the time the claim is closed, which won't be until you are as healed as you are going to get - after therapy is FINISHED.



So yes. Your insurance pays now, the other guy's insurance pays later . . ..
1. Make sure you are dealing with the auto insurance company of the person who hit you because they are liable (unless you live in a no fault state).



2. Get a copy of all the bills that you health insurance company has already paid, make 3 copies of them, and send all of them to the claims person you've been working with at the liable auto insurer. This auto insurer is liable for *ALL* of these bills including your copay and it doesn't matter that your health insurance policy has already paid it. You get to keep this money, yes it is *free money*.



3. Check your car insurance and see if you have 'medpay' coverage. If you're not sure call your insurance agent or auto insurance company. If you have it then submit the 2nd copy of the bills to your auto insurer because they are liable up to the limit of your medpay coverage. Yes this is *free money* too.



4. The car insurance company is also potentially liable for any travel costs to the appointment (might be $0.51 per mile) and any lost wages from work time you may have missed for treatment. This would be true for your policy's medpay as well.



5. Once your health insurance company stops paying the bill coordinate between the claims adjuster and the medical provider to have them mail the bill directly to the auto insurance company.



6. Continue to file claims under your Medpay as well.



7. If the auto insurer gives you any more crap consider lawyering up or start talking about how the therapy really helps with your soar neck. They can not require you to pay out of pocket first.
That is a tricky situation, if I were you, I would carefully, very carefully pour over your auto policy language, and make sure that what the agent is representing is backed up by policy language.



Call back your agent, ask him to send you a copy of the auto policy, all the endorsements, and the boiler plate policy language. Then ask him to specifically point out where in the policy the requirement for you to pay out of pocket before they reimburse you for the cost of therapy.



If he cannot point this out to you, there is a chance that he is talking out of his bottom. It happens, even good agents don't know the policy language as well as they should.



Read the language, if it states what the agent says, then you are out of luck - but it has to say exactly that - you pay, provide receipts, they reimburse - if it ambiguous, talk to you agent again.



That is really the only option, if the policy pans out as the agent states, your only recourse, is to pay first, and get reimbursed at their schedule. This is why you should really read, and understand every item on your policy - they can be changed before they are bound, afterwards, not so much.



Best of luck,