Straight Track #35 Who’s Really Paying Your Medical Bills

Who's Really Paying Your Medical Bills?

J. Dillon Hoey
Hoey & Farina Partner
1-888-425-1212

Most injured railroaders require medical treatment in order to recover from their injuries. Often, the railroader will begin receiving medical treatment without giving much thought to how and when related medical bills will be paid.

There are numerous reasons why a railroader may not immediately address this issue. This article will address the need to discuss the payment of medical bills with your FELA Designated Counsel, as early as possible following any injury.

The issue of how and when medical bills will be paid really needs to be considered well in advance of any injury. In a continuing effort to reduce the cost of benefits, railroad employees are faced with an ever-increasing number of options regarding medical coverage. A few examples will be given to illustrate the importance of considering one’s options carefully.

In most cases railroad employees are covered by an insurance policy negotiated by their union which covers them whether they are injured on or off the job. Workers' compensation laws do not apply. The railroader may be given the choice between a Health Management Organization (HMO), a Primary Physician Organization (PPO) or a private hospital association plan. Generally speaking HMO’s, as well as private hospital associations, provide medical services with less out of pocket expenses and no lifetime caps as long as you treat with the doctors and medical facilities listed on their plans. Conversely, PPO’s offer the choice of doctors and facilities, but with deductibles, percentage pays, and a lifetime cap. Though we cannot recommend one health plan over another, it is important that you consider how the various plans might impact you in the event you are injured.

Typically, following an injury a claim agent will contact you and assure you that the railroad will take care of all of your medical expenses. The railroad does not pay your medical bills. The insurance policy negotiated by your union pays the bills. A case manager, who is an agent of the railroad, may be assigned to your case for the alleged purpose of reducing your anxiety concerning medical treatment, reducing your recovery time, and coordinating your various medical needs. But, the case managers, who coordinate with the claim agents, real purpose is to steer your medical treatment in a way that reduces your claim against the railroad. The claim agent and/or case manager may even recommend that you seek treatment from a specific doctor or medical facility. Whenever possible the railroad will have your medical treatment paid by your personal medical insurance carrier. Always remember it’s your insurance paying the bills.

No matter what the claim agent and/or case manager tells you, it is important for you to know your available options. You, not the railroad, have the right to control your medical treatment following any injury. As early as possible following an injury, it is recommended that you contact your health care insurance carrier to learn exactly what medical treatment is covered and to what extent. Sometimes, your available coverage will apply to any physician or medical facility of your choice. Other times, your coverage may be limited to a specific group of physicians or medical facility.

Don’t assume that because you were injured on the job that all of your medical treatment, wherever received, will be paid. The claim agent may offer to pay the deductible, percentage difference, or co-pay. The railroad may only agree to pay your medical bills which are not covered by your plan if you follow the recommendations of the railroad as to what doctor and what medical facility you go to. The railroad may recommend a doctor or medical facility because it has developed a close relationship with the doctor or medical facility and is confident that the medical provider will focus primarily on the interest of the railroad.

If in fact the railroad refuses to pay the deductible, percentage difference or co-pay, we can contact the health care provider and offer him a letter of protection for the unpaid amount. That means that when the case is settled or verdict collected, the health care provider will be paid. The amount in question becomes part of the negotiations in a settlement or an item of damage in a trial.

Most doctors and medical care facilities handle many more work-related injuries covered by workers' compensation law than the Federal Employers’ Liability Act, which governs injured railroad workers. It is important that you explain to your doctor, or medical care provider, the type of work you do and the insurance coverage you have. Have your doctor read the document, "Knowing Your Patient, the Railroad Employee", that explains your rights as a railroad employee with regards to health care issues.

Also, health care providers may believe that they are required to obtain prior approval from the railroad before providing recommended treatment. This may be true in a workers' compensation insurance situation, but is not applicable with respect to an injured railroad worker. Typically, if your personal physician recommends surgery, no pre-approval by the railroad is necessary. However, if the doctor that the railroad sent you to recommends surgery, that doctor may need to seek approval from the railroad.

Ultimately, you should seek the best medical treatment available. The important thing to keep in mind is that you have control over where you will receive your medical treatment, based on available medical insurance coverage, the railroad’s willingness to pay for medical treatment not covered by insurance and/or your ability to independently pay for medical treatment.

The cost of medical treatment paid by your medical insurance and/or the railroad is generally not a recoverable element of damages in a claim brought against the railroad in your behalf. Medical treatment paid personally by you can be a recoverable element of damages. Even if you may not need an attorney to represent you in a claim against your employer railroad, you may benefit tremendously from discussing your circumstances with an attorney immediately after your injury.

If injured, it is recommended that you learn the details of your available medical coverage by speaking directly with your medical insurance carrier rather than the claim agent and/or case manager, and then call Hoey & Farina, your FELA Designated Counsel.