Motorcycle Accident Victims vs General Injury Health Insurance Issues

Pennsylvania motorcycle injury lawyers hear this question time and again: “Does my health insurance policy discriminate against injuries of motorcycle accident victims vs. general injuries or illnesses?”

motorcycle accident victims PennsylvaniaThe answer depends on the specific policy, the coverages you have chosen and what state the policy originates in. Most BlueCross BlueShield and/or HMO policies do not discriminate against motorcycle accident victims and will pay for all or most of the care resulting from a motorcycle accident. Deductibles and co-pays vary widely from policy to policy, therefore I suggest that everyone familiarize themselves with their specific deductibles, not only for their primary doctor and specialist, but also for emergency room, out-patient and in-patient hospital stays. In-patient deductibles might vary from $250 – $1,000 per day for each of the first five or more days that a motorcycle accident victim spends in the hospital.

Many employer-supplied health insurance policies are self-funded or partially self-funded by the employer themselves. In this situation, the money to pay for the motorcycle accident victim’s incurred bills is actually coming from employee contributions and the general assets of the employer. Typically the employer hires a subsidiary of the large insurance companies as a third-party administrator to handle the plan. These plans look and smell like more traditional plans but often have more exclusions and restrictions, as it is the employer who controls the plan.

One major difference between an employer sponsored plan and a traditional health insurance plan is that virtually every employer sponsored plan has a “subrogation agreement” meaning that if they pay your medical bills, they will want most, if not all, of their money back should you recover from the person responsible for your motorcycle accident.

A variety of Union-sponsored plans also hire a third party to administrate their plan. These tend to be the most restrictive plans when it comes to the type of medical services they will pay for, and are usually very strict in enforcing their “subrogation” language. The most restrictive of these plans that I have seen are generally New Jersey based. In many of the Jersey plans they restrict the type of treatment they will pay for if it is related to a motorcycle accident, and I also recall seeing some plans that exclude paying for any treatment related to a motorcycle accident.

While a motorcycle crash lawyer can answer general questions like this after an accident, I urge you, to pull your plan documents and spend a few minutes getting to know what, if any, coverage would be provided if you are involved in a motorcycle accident in Pennsylvania or New Jersey. There may also be restrictions on where the treatment must be performed. Failure to comply with the restrictions in your health insurance plan could end-up leaving you owing thousands of dollars in medical bills, simply because you failed to follow the guidelines set forth in your plan.

If you have been in a motorcycle accident contact Pennsylvania motorcycle accident attorney Lee D. Gaber at 1-888-CYCLE-LAW (1-888-292-5352) to get your insurance questions or issues handled.

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