If you are injured by someone else and collect a personal injury settlement, you are generally legally obligated to reimburse from the personal injury settlement the private insurance or government agency that paid your medical bills.
Many people assume that they can prove the amount of medical bills that should be included in their personal injury claim by simply producing their medical bills. This is not the case. Every dollar of the medical bills must be proven as a reasonable charge, unusually by expert testimony.
Insurance companies often hire experts to try to prove that the injured person’s medical bills should be no more than Medicaid or Medicare would pay—even if the injured person is not on Medicaid or Medicare.
Medicaid and Medicare reimbursement rates do not reflect fair market rates for medical services. In fact, according to the American Hospital Association Medicaid and Medicareoften pay hospitals and doctors less than it costs the hospital or doctor to provide the medical services. [1] Yet the insurance companies pay expensive experts to try to underpay an injured person even for their medial bills, by paying only what Medicaid or Medicare pay. A personal injury settlement can be a trap for the unwary, rather than a fair resolution. Speak to a personal injury attorney before accepting a personal injury settlement.
[1] See https://www.aha.org/factsheet/2017-01-01-underpayment-medicare-and-medicaid-fact-sheet-2016-update .