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Jon Lewis
Jon Lewis
Attorney • (888) 295-7409

The Almighty Dollar Controls

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I just got off the phone with an orthopaedic group’s business office. My client was in a car wreck last week. She went to her orthopaedic today with her BlueCross and BlueShield card. Their office told her that they will not accept her BlueCross if she was in a wreck. They wanted the person’s insurance company, State Farm. She told me that they file with State Farm first, and if they get paid, they don’t file with BlueCross.

Now, why is this? Well, BlueCross has shoved the rates down on medical providers. These medical providers, doctors, hospitals, etc., have realized that they can recover more from the auto insurance companies than they could with their agreed upon contract with BlueCross. For Example: If a doctor’s bill is $1,000.00, BlueCross might only pay $600; however, the doctor isn’t bound by the BlueCross rate when they get a company such as State Farm to pay it so they can ostensibly collect the full $1,000 from State Farm. They make more money.

Why do State Farm and Allstate and other insurance companies agree to do this? They lower the damages for the patient/injured victim. If State Farm pays the doctor directly, they can argue that they have reduced the patient’s damages and offer lower amounts to settle the case. So, the insurance company saves more money on claims.

Who loses? YOU DO!!! The patient. The injured victim. Why? You pay your BlueCross Premiums which isn’t even accepted. You are the one who is injured and has to go to the doctor, therapy, get your car fixed, live with the pain, etc., and you get less and less form these insurance companies who have figured out how to game the system. The doctors make more and the insurance company makes more.

Until people are affected personally, these issues don’t matter. However, as my client just told me, who wants to go to a doctor and be told, "There is a phone book out there. Go look up State Farm’s number." You pay for BlueCross. You are injured. But, you have to do the work and recover less.