Sam C. Rumph, III
What is Med-Pay and Why Do I Need It?
Medical payments coverage is an optional add-on provision to your automobile insurance policy. It is not required coverage in Georgia, but it is certainly recommended even if you have other health care coverage. Why? It is the most affordable health insurance you can have to cover your health expenses as a result of a car accident and can even be used to cover out of pocket expenses, deductibles, coinsurance, or co-pays with other health insurance.
In Georgia, the typical med pay policy will cover expenses incurred up to three years from the date of the accident. O.C.G.A. § 33-34-2(1). So, what’s covered? If this coverage is selected, the standard Georgia policy requires your automobile insurance company to pay the “reasonable expenses incurred for necessary medical and funeral services because of bodily injury caused by accident and sustained by an ‘insured.’” Jenkins, Frank E., III & Wallace Miller, III, Georgia Automobile Insurance Law Including Tort Law with Forms, App. B (2012-2013 Ed., Thomson Reuters). Georgia law, O.C.G.A. § 33-4-6, requires the insurance company to pay these bills within sixty (60) days of submission of the bill to the insurance company or they may be subject to penalties.
Who can be covered by this type of insurance? Typical policies use a term called “covered persons.” Again Georgia law provides standardization by requiring that “coverage shall be available to the named insured, resident spouse, and any resident relative while occupying the covered motor vehicle, and to any other person legally occupying a covered motor vehicle.” O.C.G.A. § 33-34-2(1). Of course, this definition is packed with terms that require inquiry in the actual policy for clarification, but just a casual reading provides insight as to what should be covered. With any contract, you should closely read the terms to understand exactly who and what is covered.
How much coverage is available? This can vary a bit, but the Georgia Commissioner of Insurance requires insurance companies to offer at least the following limits: $1,000, $2,000, $5,000, $10,000, $25,000, and $50,000. (Directive No. 91-PC-29, dated May 2, 1991).
How much coverage is recommended? Certainly, you should talk to your insurance representative about this because he or she can provide up to date cost projections for emergency medical care. Our recommendation is that you should have a minimum of $10,000 coverage, but you should get as much as your budget will allow. It is not expensive and there are no pre-existing condition exclusions. For instance, a $50,000 med pay endorsement can cost less than $100 per year.
Why is this coverage so important to have? A typical ambulance bill ranges anywhere from $700-$1,100. A basic emergency room examination with minimal testing like an X-ray can run $2,500 or more; but, if more extensive diagnostic testing or treatment is needed, your initial emergency room visit can be over $5,000. Add emergency surgery, and the costs skyrocket. Also consider that if you are severely injured, a single night in an intensive care unit (ICU) alone can soar in excess of $20,000.
If you have no health insurance, the choice is obvious.
However, even if you have health insurance, medical payments coverage is still a wise choice. It is certainly foreseeable with these examples that you may have significant medical bills remaining after your deductible and coinsurance pay. For instance, a good health insurance policy may have a $1,500 deductible, and then it will pay 70% after the deductible is met. This means you could be left with medical bills after insurance pays in the range of $2,250 (basic ER + ambulance) to $7,050 (just one night in ICU alone with nothing else). To make matters worse, increasingly we are seeing health insurance or health care providers denying claims where the injuries are a result of car wreck.
Consider also that if you are injured and require additional treatment or therapy over a period of time, you can see how these bills quickly add up with or without health insurance. Bills that ultimately that you are responsible for paying.
To make sure that you have enough coverage, we recommend that you discuss your decision with your qualified insurance representative. You may always contact us for a free initial consultation.
- Jenkins, Frank E., III & Wallace Miller, III, Georgia Automobile Insurance Law Including Tort Law with Forms, § 28 (2012-2013 Ed., Thomson Reuters)