Mark Gottlieb, a marketing consultant, was involved in a car accident after a driver crashed into his vehicle at an intersection in New Jersey. The following months were agonizing as he experienced debilitating neck pain despite undergoing physical therapy and chiropractic care.
Mark’s doctors advised him to go for an operation at Hudson Regional Hospital in Secaucus. The complex type of fusion surgery involved replacing damaged herniated disks in his cervical spine with implants. While it relieved the excruciating pain, Gottlieb plunged into some shocking medical bills. Here’s a breakdown.
Gottlieb’s Medical Bills
Hudson’s Regional Hospital medical bill consisted of:
- The cost of surgery: $445,995
- The price of the main surgeon: $264,444
This means Gottlieb needed to pay more than $700,000 to clear the bill despite having a car accident insurance policy, PIP (Personal Insurance Protection) cover, and a health insurance policy.
Generally, the car insurance company is responsible for paying medical bills after an auto accident. However, unlike health insurance providers, car insurance companies are not part of health insurance networks.
As such, they’re likely to pay higher medical costs because they aren’t entitled to discounts available to providers within health insurance networks. This is what happened in Mark Gottlieb’s case. While Geico, his car insurance company, paid a substantial amount ($245,000), it wasn’t enough to clear the whole medical bill.
A detailed analysis of the cost shows Gottlieb’s surgeon and hospital charges were eight times higher even after being reduced by Geico. The high costs got Gottlieb exhausting his PIP cover too, as the bills kept rolling in. He used the cover to pay Bergen Pain Management Clinic the remaining $52,365 to reimburse the bill. Still, the clinic is entitled to $89,183.55 of the balance for the surgery.
Does the Health Insurance Cover Pay for Any Cost?
Gottlieb also has a health insurance cover with Aetna, but his efforts to claim compensation for the surgeon’s cost bore no fruit. This is because both Bergen Pain Management Clinic and the surgeon aren’t part of his health insurance network.
Therefore, Aetna can’t negotiate an affordable rate with the clinic to reduce the cost. The company mentioned it would pay an out-of-network payment of $4,051 only based on Gottlieb’s policy terms.
While this was somewhat encouraging, it turns out Gottlieb is liable to pay for the amount out-of-pocket. According to Aetna, he hadn’t met his annual out-of-network deductible.
The Main Takeaway
The car insurance policy covers bills associated with car accidents first, and it operates differently from health insurance covers. Also, a PIP cover that’s part of a car insurance policy depletes rapidly when used to pay for non-emergency treatment. As such, when signing up for extensive non-emergency treatment, ensure the providers are part of the network of your health insurance company.