Who pays my medical bills while the case runs?

Your own PIP pays first — 80% of the bills, up to $10,000, and only if you were seen within fourteen days. Health insurance or a letter of protection covers what PIP did not. The at-fault driver’s insurer pays nothing along the way: it pays once, at the end, in a single sum against a release, and whoever carried the cost in the meantime is repaid out of that. Nobody sends the bill to the driver who caused it.

01 Why the bills come to you

Liability insurance does not pay as you go

There is no account that medical bills are charged to while a claim is open. The at-fault driver’s liability coverage pays once, at the end, in one sum, in exchange for a release. Until that happens the hospital, the imaging center and the orthopedist are looking at the person who received the care, which is you.

That single fact explains most of what feels wrong about the first two months. The crash was not your fault, the bills are arriving anyway, and the company that will eventually pay is the one company nobody can send an invoice to.

It also explains collections letters during a perfectly healthy case. A collections notice is not a judgment on the claim. It is usually a billing department that does not know a claim exists, because nobody told it. That is fixable in a phone call, and it is worth fixing early — a bill that goes to collections is harder to resolve out of the settlement than one that was flagged as accident-related from the first visit.

A collections letter during an open claim is not a verdict on the case. It is a billing department that does not know the case exists.

02 What PIP actually covers

PIP pays first, and the $10,000 is not automatic

Florida requires every driver to carry $10,000 of Personal Injury Protection, and it pays regardless of who caused the crash. It covers 80% of reasonable and necessary medical expenses and 60% of lost gross income, and it pays nothing at all unless initial care is received within fourteen days of the crash (§ 627.736).

The $10,000 figure depends on something most people have never heard of. PIP reimburses up to $10,000 only where a physician, dentist, physician assistant or advanced practice registered nurse determines that the injury was an emergency medical condition. Where a provider instead determines that it was not, reimbursement is limited to $2,500. The determination that it was an emergency medical condition can only come from that short list of providers; the determination that it was not can come from a wider group, chiropractic physicians among them.

So a claim can be handled competently, treated promptly, and still stop at $2,500 — not because anything went wrong, but because nobody on the narrow list ever wrote the determination down.

And 80% is not 100%. Even inside PIP, a fifth of every covered bill is left over. That balance does not disappear. It sits with the provider until something resolves it, which is the settlement, a health plan, or you.

03 Health insurance

Use the health insurance, even when it feels like helping the wrong side

The instinct is that using your own health plan lets the at-fault driver’s insurer off cheaply. Since 2023, Florida law makes close to the opposite true, and this is the single most expensive misunderstanding in an injury case.

§ 768.0427, enacted by chapter 2023-15, Laws of Florida, controls what a jury is allowed to be told a medical bill was worth. For a bill that has already been paid, the admissible evidence is the amount actually paid, whoever paid it. For a bill that is unpaid and you had coverage, it is what the coverage is obligated to pay the provider, plus your own share.

Here is the part that matters. Where you had health coverage but treated under a letter of protection instead of using it, the measure is still what that coverage would have paid. Declining to use the card does not raise the number a jury may hear. It only changes who is owed at the end, and leaves you owing a provider on terms that were never negotiated.

Where there is no coverage at all, or where Medicare or Medicaid applies, the admissible amount is 120% of the Medicare rate — or 170% of the state Medicaid rate where no Medicare rate exists. The large number printed on a hospital statement is, in nearly every case, not the number the claim can be built on.

04 Letters of protection

What a letter of protection does, and what it now has to disclose

A letter of protection is an agreement that a provider treats now and is paid out of the recovery rather than at the time of care. For someone with no health insurance and a specialist referral they cannot otherwise act on, it is often the only way the treatment happens at all, and treatment that happens is what a claim is made of.

What changed in 2023 is the paperwork. Under § 768.0427(3), disclosure is a condition precedent to claiming those medical expenses at all. That means a copy of the letter itself; itemized billing coded the way the statute requires; if the provider sold the receivable to a factoring company, the buyer’s name and what it paid, discount included; whether you had health coverage at the time; and whether an attorney referred you to that provider — a referral the statute makes disclosable notwithstanding the lawyer-client privilege in § 90.502.

None of that is a reason to avoid a letter of protection. It is a reason the paperwork has to be right from the first visit rather than reconstructed two years later, and a reason to say plainly who sent you where.

05 Who gets repaid

At the end, whoever carried the cost is repaid out of the recovery

A settlement is not all yours. Before anything reaches you, the people who paid along the way are repaid from it — the health plan under its own subrogation terms, the providers holding letters of protection, and any government program that paid.

Medicare pays conditionally when another payer is responsible and recovers those conditional payments from the settlement under the Medicare Secondary Payer statute, 42 U.S.C. § 1395y(b)(2). Ignoring it does not make it go away; it makes it expensive.

Medicaid is the one with a deadline. Florida’s agency holds an automatic lien on any third-party recovery, perfected from the moment treatment is first received (§ 409.910). Its default share is set by formula: after attorney’s fees and taxable costs, half of what remains goes to the agency up to what Medicaid actually paid, with the fee treated as 25% — which comes to 37.5% of the gross recovery unless somebody challenges it.

It can be challenged, and the window is short. A recipient may show by clear and convincing evidence that a smaller portion of the recovery represents medical expenses, but only by petition to the Division of Administrative Hearings within twenty-one days, and the clock starts when the agency is paid or the money is placed in trust for it — not when somebody notices. That is the whole remedy, and it is the single most commonly missed deadline in this part of a case.

Twenty-one days to challenge the Medicaid number, counted from when the agency is paid — not from when somebody notices.

07 What to do now

1. Be seen within fourteen days, and say it was a crashMiss that window and PIP pays nothing, however serious the injury turns out to be. Saying the visit is crash-related is also what gets the bill coded in a way that can be found later.
2. Ask whether an emergency medical condition determination was madeAnd by whom. Without one from a physician, dentist, physician assistant or advanced practice registered nurse, PIP stops at $2,500 instead of $10,000.
3. Give the clinic your health insurance cardEven when you are told not to bother. Using the coverage you have does not shrink the claim, and declining to use it does not grow it.
4. Keep every explanation of benefitsNot just the bills — the statements showing what the plan paid and what it refused. That is the document that establishes the amount the law lets into evidence.
5. Say out loud whether Medicare, Medicaid, TRICARE or VA coverage is involvedEach has its own repayment rules and one of them has a twenty-one-day deadline. This is the question most people answer late, and late is where it costs money.
6. Answer the collections letter instead of filing itTell the provider a claim is pending and give them the claim number and the adjuster. A bill flagged as accident-related is straightforward to resolve at the end. One sitting in collections is not.

09 The sources

• Fla. Stat. § 627.736 Personal Injury Protection80% of medical expenses and 60% of lost income to $10,000, the fourteen-day deadline, and the $2,500 limit where no emergency medical condition is determined.
• Fla. Stat. § 768.0427 Evidence of medical damagesWhat a jury may be told a bill was worth, and what a letter of protection must disclose before those expenses can be claimed. Enacted by ch. 2023-15, Laws of Florida.
• Fla. Stat. § 409.910 Medicaid third-party liabilityThe automatic lien on a recovery, the default repayment formula, and the twenty-one-day window to contest it.
• 42 U.S.C. § 1395y(b)(2) Medicare Secondary PayerMedicare pays conditionally when another payer is responsible, and recovers those payments from the settlement.
• Fla. Stat. § 95.11 Time limitsTwo years for most negligence claims accruing on or after March 24, 2023.