Medical bills incurred due to nursing home injuries can be high. Whether it’s an infected pressure sore or a broken hip from a fall accident, getting medical bills paid can be incredibly stressful. Below is a brief discussion about how medical bills get paid after a nursing home injury (accident, neglect, abuse, etc.).
The Role of Insurance
Medicare or Medicaid is probably the most common type of health insurance for residents of long-term care facilities like nursing homes. In fact, the vast majority of nursing home residents have Medicare which covers hospital stays, surgical treatment, doctor’s visits, etc. Accordingly, Medicare steps in and pays for medical bills when a nursing home resident is injured due to abuse, neglect or an accident. The same principle applies to residents of care facilities who have Medicaid.
2. Private Health Insurance
Some residents of care facilities have private health insurance. This is especially true in rehabilitation care facilities or other short term care facilities. Someone who is injured in an accident at a rehab care facility in PA would have their medical bills paid by their private health insurance company.
Out of Pocket Medical Costs
Co-pays and payments for co-insurance or deductibles are paid out of pocket. In addition, there may be miscellaneous out of pocket expenses related to necessary medical care, such as a cane or walker. In some cases, a motorized wheelchair may be necessary, and the accompanying co-pay or deductible could be quite high. In serious injury cases, medical out of pocket costs can easily total thousands of dollars.
Financial Recovery for Medical Bills
Residents of long term care facilities like nursing homes who are injured due to neglect, abuse or due to accidents can obtain fair and reasonable financial compensation by filing injury lawsuits in the Pennsylvania courts. Claims for monetary compensation can be made for medical bills, out of pocket costs, lost wages (if applicable) and pain and suffering.
It is important to note that in many instances, the plaintiff in a nursing home injury lawsuit in PA can make a claim for medical bills which were already paid by insurance (i.e., Medicare/Medicaid or private health insurance). However, Medicare and Medicaid rules generally require that the injured plaintiff repay what was paid out.
For example, a nursing home resident in Philadelphia is injured after she falls from her bed. She suffers a serious hip fracture and requires surgery. Medicare pays $10,000 for her medical treatment. The resident files a lawsuit against the nursing home and obtains a financial settlement. She must then turn around and repay Medicare a specified portion of the $10,000 it paid out on her behalf. This type of arrangement is known as a right of subrogation or a lien.
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Our law firm focuses on injury and accident cases including nursing home negligence cases. Call the firm to discuss your legal rights. We offer free consultations. (215) 985-0777
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