What Do I Do with the Check?
MedPay reimbursement is designed to cover medical expenses related to your accident. Assuming you do not have any medical liens, it is our recommendation that any MedPay checks you receive be used to pay off outstanding medical bills. The goal of an insurance claim is to get back what an accident cost you so that once you have reached a final settlement, you know that everything is taken care of and that you do not owe any money to any other medical provider. However, this will only be the case if you make sure to pay off your bills from your medical providers.
If you have already paid all of your medical providers, then what you receive is a true reimbursement check, meaning you can do with it as you see fit. Before you do anything with the money, you should contact each medical provider and confirm that you owe a $0 balance. It’s a good idea to get that confirmation in writing.
Important: If you have any medical liens, this process must be handled differently. Please review our guides on liens.
How Do I Know Which Treatment the Check Is For?
When the MedPay adjuster sends you the check, they should also include a document called an Explanation of Reimbursement (EOR), which contains an explanation of what was reimbursed related to your Medical Payments Claim.
This document will list information relevant to your claim, such as:
- The claim number
- Adjuster information
- Date of accident
It will also specify details about the reimbursement and should correlate with a Medical Payment check.
For example, if you submitted medical bills and records for a visit to the emergency room that cost $1,300 and have a MedPay limit of $1,000, you may receive a $1,000 check in the mail along with an EOR. This EOR should indicate the medical provider who provided the service related to the accident (the emergency room, in this case), the date of service received (or the date you went to the emergency room), the total amount charged (the $1,300), and the total amount reimbursed (the $1,000). In this case, you will probably see a note that $300 was not reimbursed due to the Medical Payment Reimbursement maximum being reached. This is to be expected and is nothing to be concerned about.
If you only have $1,000 in coverage, you cannot get reimbursed for that remaining $300 from your MedPay coverage. Depending on the company, you may get a letter in the mail a few days letter called an “Exhaustion Letter,” stating that your MedPay limit has been exhausted. This means the adjuster has paid all they would have to pay for your claim and will be closing your claim.
However, if you have a $2,000 MedPay limit in that same scenario, your EOR will likely show that $1,300 was charged and $1,300 was covered. This means that you still have $700 remaining in MedPay coverage. You should get EORs for each check you receive, and it is a good idea to verify that each check matches its EOR. If for some reason your EOR says you are going to be reimbursed $1,300 but you are only reimbursed $1,200, there may be a check printing error and you should call your adjuster immediately.
Depending on the company, your adjuster may send an Explanation of Reimbursement letter before your check, after your check, or with your check. If for some reason you get a check and do not get an EOR letter, call the insurance company and request that one be sent to you immediately.
Will Filing a Medical Payments Claim Raise My Premium?
Since MedPay is a no-fault insurance coverage, it is considered contractual in nature and, as such, should not cause your premium to increase. However, the specific nature of your contractual relationship is governed by the terms of your insurance policy with your insurance company or the insurance company providing coverage. It may be advisable to review the exact nature of the applicable insurance policy to determine the terms and nature of the contractual relationship.
When Will MedPay Not Apply?
There are numerous exclusions associated with North Carolina MedPay insurance policies that prohibit this type of coverage or exclude it from applying.
Here, we have listed some of the most common North Carolina MedPay exclusions that provide no coverage to any person for bodily injury received:
- While occupying a taxi or while transporting people or goods for money
- While occupying a motorhome or recreational vehicle
- While occupying any vehicle during the course of employment if workers’ compensation coverage is required or voluntarily given
- While occupying a vehicle without permission
- As a result or consequence of war, civil war, insurrection, rebellion, or revolution
- While using, operating, or occupying any motorized vehicle having less than four wheels
