The Personal Injury Process: Who Pays for My Surgery?

Personal Injury

It is very serious when a client requires surgery to alleviate the physical pain caused by someone else’s negligence. Surgery is not only a big medical decision, but it is also expensive. This blog will walk you through what happens when surgery is necessary and figuring out who pays for it.

First, the client must make the important choice of whether to have surgery or not. The client’s treating medical providers and surgeon can provide all the information on the medical side. They will explain the benefits of the surgery, the risks, likelihood of success, the recovery process, and ultimately, their recommendation. We typically recommend the client seek a second opinion so they can make the best decision for their body.

Next, let’s assume the client has consulted with their doctors and got a second opinion; and after discussing it with their friends and family, decides they need the surgery. As part of the client’s case, we will communicate with the surgeon and surgical facility regarding whether they accept the client’s health insurance or if the surgery will be performed under a “letter of protection”.

If the client’s health insurance will cover the costs of the surgery, we typically recommend that they use their health insurance. If health insurance covers the surgery, the health insurance company will have a lien on any settlement secured by the client in the amount they paid for the surgery. Even though the insurance company will have a lien, that lien amount is typically less than the full-blown cost of surgery.

If the client does not have health insurance or their insurance does not cover the surgery, the surgeon will usually perform the surgery under a “letter of protection”. This means that the client will enter into a contract with the surgeon that allows the client to get the surgery, and then pay for it later with the funds recovered from their personal injury settlement. If there is there is not enough of a financial recovery to pay the full cost of the surgery, we will work with the client and the doctors to negotiate how everyone will share in the proceeds.

In a personal injury case, having surgery requires a lot of background work and coordination between the medical and financial sides of the case to ensure that the client maximizing their recovery. Your case needs this kind of personalized attention, and Robert Sparks Attorneys provides it.