The Short Answer

Unfortunately, it is often legal for health insurance companies to deny claims related to auto accidents. This comes down to something called “coordination of benefits” clauses that are written into most insurance policies. 

However, there are still things you can do to appeal the decision, get an external review, or get your ER bills paid through another route. I’ll explain more below.

Why Florida Health Plans Often Deny Accident Claims

Most Florida health insurance contracts have a coordination of benefits (COB) clause. According to Insuranceopedia, Coordination of Benefits rules explain which policy is the primary policy that should pay off first in the event a policyholder has two policies covering the same illness or injury. This says that if you have another insurance policy covering the same illness or injury, that policy should pay first before your health insurance kicks in.

So, if you have Florida auto insurance, Florida law requires that they pay first, and the health plan expects it to fully handle accident injuries like your ER visit. From their view, this avoids double payments and saves them funds.

But here’s the issue – what if your car policy’s accident coverage falls short of that pricey ER bill? Legally in Florida, the health insurance company cannot completely abandon you with unpaid balances after auto coverage maxes out. However, it may take effort to hold them accountable.

Additionally, even with auto-accident exclusions, your policy likely has emergency and follow-up protections that legally require some cost coverage. For example, under the Prudent Layperson Standard, insurers must cover expenses for ER visits made in good faith belief that an emergency existed. 

What’s more, they cannot deny payment for genuine emergency services like setting broken bones or receiving life-saving intervention during a crisis. Coverage may also extend to post-stabilization care defined under your policy’s protections.

How to Appeal a Claim Denial

Just because your health insurer sent an initial claim denial doesn't mean you have to foot that huge bill yourself. Here's what to do next:

• Step 1: Submit the Claim to Your Car Insurance 
• First, go through the process of submitting the emergency room claim to your auto insurer. Hopefully, they approve and cover some or all of the costs. Get any payment/denial you can from them in writing.
• Step 2: Resubmit Paperwork to the Health Insurer 
• Next, go back to your health insurance with documentation that shows your car insurer's payment (or denial). Resubmit forms asking them to process their portion of the claim. Make it clear these are leftover balances you need help with. Provide:
• A copy of the car insurance payment or denial letter
• Copies of the emergency room bills, highlighting unpaid balances 
• A letter formally requesting the health insurer cover the remaining costs
• Step 3: File a Formal Appeal 
• If your health insurance still refuses at this point, file a formal internal appeal. Outline the steps you took, emphasize that balances remain, and state that you rely on your health policy to fill the gaps. 

The appeal should trigger a process requiring the company to take a second look. Quote your policy's language about their responsibility for copays or deductibles other insurance does not cover. Explain how denying further payment leaves you underinsured relative to the premiums you paid.

By law, this formal appeal process often succeeds in overturning the original claim denial. 

If that fails, an external appeal to an independent review organization may be an option. In Florida, the Florida Office of Insurance Regulation is the agency to contact to learn more about how to request this third-party appeals step in your situation if needed.

Other Routes to Pay Those Bills

If appeals don't work with either insurance company, two additional options include:

1. Negotiating directly with the hospital and providers on a payment plan or discounted rate. Inform them of your accident-related financial hardship and try to settle reasonable out-of-pocket costs you can manage. Many institutions have financial assistance programs or options to break up balances into affordable monthly payments. Discounts may also apply for paying cash sums in lump installments.

2. Consult a personal injury attorney. The at-fault driver from your accident may also carry liability coverage regarding injury-related expenses through their own auto insurance. Speaking with a personal injury attorney could introduce options for securing coverage or compensation through that party as well. Your attorney can advise if suing the at-fault driver from the accident for reimbursement of medical costs is feasible. This route also opens the door to securing a settlement both covering bills and compensating beyond just economic damages.

Conclusion

Stand your ground with the insurers. Financial responsibility for accident-related health costs often falls into confusing gaps and gray areas between health and auto policies. But Florida regulations ultimately hold insurers accountable for paying legitimate claims. Though it may require resubmission, appeals, negotiation, or the advice of a legal expert, there are still ways to get those vital bills paid.

Sources

• https://www.insuranceopedia.com/definition/5485/coordination-of-benefits-cob 
• https://www.floir.com/ 

"The information provided herein is simply a brief overview of the Florida law on this particular matter. It should not be relied upon for legal purposes, as the facts and circumstances to any specific legal matter may vary substantially from the limited explanation and application of often complicated legal rules and principles that may be addressed herein, or applicable in your particular legal matter. You should only rely upon legal advice provided to you by a licensed attorney who has had an opportunity to fully evaluate your particular legal matter".