Who Pays for Medically Unnecessary Services for Injury Victims in WA State?
When a person is injured badly they typically seek medical treatment from a qualified medical care provider. Imagine if you are injured in an accident through no fault of your own and you seek and receive medical care but when you try to recover damages, the defendant’s attorney or insurance company claims that you received unreasonable or medically unnecessary services. What if they are right? Should the injured victim now be responsible to pay for that medical care even though it was not their fault that they were injured and then received unnecessary procedures/services? No they should not but who pays?
Who pays for medically unnecessary services for injury victims in WA State?
When a person is injured in Washington State, the at-fault person or entity is ONLY responsible for medical care that is deemed “reasonable and necessary.” They are NEVER responsible for medical negligence and/or improper and/or unnecessary care. Damages for unnecessary services would need to be recovered separately in a personal injury lawsuit against the care provider.
If you are the victim of an accident and are unsure if the treatment being prescribed for your injuries is reasonable or if you are battling an insurance agency who claims that your medical care was unnecessary or inappropriate; seek the help of an experienced personal injury lawyer. He or she will evaluate your accident, injuries and treatment and discuss your legal rights.
What are medically unnecessary services?
Medical necessity is defined and interpreted in different ways by different groups including physicians, courts, government insurers, private insurers, and patients.
Medicare, for example, considers medical procedures and other services “medically unnecessary” when they are not “reasonable and necessary for the diagnosis or treatment of illness or injury.” Broadly speaking, unnecessary medical care can be defined as treatment that is not evidence-based and can often be tied to excessive testing, prescribing and/or surgery.
This shows that while patients should be able to trust their medical providers to provide only appropriate medical services, the reality is that medically unnecessary services are provided on a regular basis. To that point, in December, 2017, The Department of Justice announced that it had recovered more than $3.7 billion in settlements and judgments from civil cases involving fraud and false claims against the government (Medicare) in the fiscal year ending Sept. 30, 2017. This brings total recoveries since 1986 (the year that Congress substantially strengthened the civil False Claims Act) to more than $56 billion.
Unnecessary medical care for accident-related injuries
Medically unnecessary services account for up to 30 percent of total healthcare spending. The reasons for this are many and varied including health care providers not up to date on the latest medical research, reimbursement abuse, misdiagnosis and a desire to provide the easiest treatment instead of the best.
Some examples of unnecessary medical care for accident-related injuries include:
- Surgery for meniscal cartilage tears. Undergoing surgery for torn meniscal cartilage is found to have few benefits over conservative management and rehabilitation.
- CT or MRI scans for low-back pain. CT and MRI scans have been found to be inappropriate for patients not exhibiting neurological problems.
- Spine operations. Doctors sometime perform operations to fuse vertebra or to remove ruptured disks. This type of surgery may not solve the issue and can actually cause other problems or the need for spinal injection of steroids to manage pain.
If you or a loved one is dealing with an accident or injury through no fault of your own, you have enough on your plate. Let an experienced accident attorney fight for the full compensation that you deserve. It is not uncommon to receive a settlement from the insurance company that is five to ten times larger with the help of a lawyer. Call the caring accident attorneys at Tario & Associates, P.S. in Bellingham, WA today for a FREE consultation! We have been representing residents of Whatcom County, Skagit County, Island County and Snohomish County since 1979. You will pay nothing up front and no attorney fees at all unless we recover damages for you!