Monday, August 24, 2015

How do Hospital Bills Get Paid After an Accident in Las Vegas?

After a serious car crash, you may be transported to the nearest hospital for immediate medical treatment.  If your injuries are life threatening, you may be taken to UMC hospital, since it is the only level 1 trauma center in Las Vegas.  UMC’s doctors and staff are equipped to handled the most serious injuries that typically happen in motorcycle and semi-truck accidents.  

However, this type of emergency room treatment is costly.  If you do not have health insurance, then all major hospitals are required to reduce their bill by 30%. All hospitals in Las Vegas are considered “major hospitals”, except for the County run, UMC hospital. So, if you went to UMC, they are not required to reduce their bill by the statutory 30%.  This law is found in NRS §439B.260, which allows for the 30% reduction and states in part:

NRS 439B.260  Reduction of billed charges for certain patients and services; notice; resolution of disputes.
      1.  A major hospital shall reduce or discount the total billed charge by at least 30 percent for hospital services provided to an inpatient who:
      (a) Has no policy of health insurance or other contractual agreement with a third party that provides health coverage for the charge;
      (b) Is not eligible for coverage by a state or federal program of public assistance that would provide for the payment of the charge; and
      (c) Makes reasonable arrangements within 30 days after the date that notice was sent pursuant to subsection 2 to pay the hospital bill.
      2.  A major hospital shall include on or with the first statement of the hospital bill provided to the patient after his or her discharge a notice of the reduction or discount available pursuant to this section, including, without limitation, notice of the criteria a patient must satisfy to qualify for a reduction or discount.
      3.  A major hospital or patient who disputes the reasonableness of arrangements made pursuant to paragraph (c) of subsection 1 may submit the dispute to the Bureau for Hospital Patients for resolution as provided in NRS 223.575.
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There are additional laws in the state of Nevada on how hospitals can collect after car or other motor vehicle accidents. These laws are set forth in NRS 449.758 and 449.757.  These laws apply if you do in fact have health insurance and that health insurance company has a contract with that hospital. If this is the case, then the hospital must bill your health insurance and not seek payment from any settlement you may have with the at fault driver:

NRS 449.758  Limitations on efforts of hospital to collect when hospital has contractual agreement with third party that provides health coverage for care provided; exception.

      1.  Except as otherwise provided in subsection 2, if a hospital provides hospital care to a person who has a policy of health insurance issued by a third party that provides health coverage for care provided at that hospital and the hospital has a contractual agreement with the third party, the hospital shall proceed with any efforts to collect on any amount owed to the hospital for the hospital care in accordance with the provisions of NRS 449.757 and shall not collect or attempt to collect that amount from:      (a) Any proceeds or potential proceeds of a civil action brought by or on behalf of the patient, including, without limitation, any amount awarded for medical expenses; or
      (b) An insurer other than a health insurer, including, without limitation, an insurer that provides coverage under a policy of casualty or property insurance.

    NRS 449.757  Limitations on efforts of hospitals to collect; date for accrual of interest; rate of interest; limitations on additional fees.
      1.  When a person receives hospital care, the hospital must not proceed with any efforts to collect on any amount owed to the hospital for the hospital care from the responsible party, other than for any copayment or deductible, if the responsible party has health insurance or may be eligible for Medicaid, the Children’s Health Insurance Program or any other public program which may pay all or part of the bill, until the hospital has submitted a bill to the health insurance company or public program and the health insurance company or public program has made a determination concerning payment of the claim.
      2.  Collection efforts may begin and interest may begin to accrue on any amount owed to the hospital for hospital care which remains unpaid by the responsible party not sooner than 30 days after the responsible party is sent a bill by mail stating the amount that he or she is responsible to pay which has been established after receiving a determination concerning payment of the claim by any insurer or public program and after applying any discounts. Interest must accrue at a rate which does not exceed the prime rate at the largest bank in Nevada as ascertained by the Commissioner of Financial Institutions on January 1 or July 1, as the case may be, immediately preceding the date on which the payment becomes due, plus 2 percent. The rate must be adjusted accordingly on each January 1 and July 1 thereafter until the payment is satisfied.
      3.  Except for the interest authorized pursuant to subsection 2 and any court costs and attorney’s fees awarded by a court, no other fees may be charged concerning the amount that remains unpaid, including, without limitation, collection fees, other attorney’s fees or any other fees or costs.
After reading the above Nevada law, if you have health insurance, the hospital must bill the health insurance first.  However, if you have Medicare as your primary ‘health insurance’, this law does not apply.  The reason for this, is that Medicare is governed by Federal law and Federal law trumps State law.  So next time, we will discuss how what happens if you have Medicare.