What Do You Owe After an Accident: Part 2

Brittany Adams
Aug 14 · 3 min read

sunset bike

How an accident can cost nearly $5,000 - even with health insurance

Last week we looked at what your health insurance plan includes, and what different elements of your insurance ID card mean. Need a refresher? Click here to review part 1 of this 3 part series.

Now that you’ve read about what health insurance plans do (and do not) cover, you may be wondering how all those benefits work together. Even with great health insurance, you could still end up owing thousands out-of-pocket after an accident. So, how can you calculate roughly how much you may owe out-of-pocket after an accident if you have health insurance? For the following example, let’s say you have an accident mountain biking and you tear your ACL, requiring surgery.

Even with great health insurance, you could still end up owing thousands out-of-pocket after an accident.

Let’s assume at the time of the accident you have an individual health insurance plan that is fully compliant with the Affordable Care Act and has a $2,500 deductible. Your total cost of care for the accident ends up being $13,000. With all of the imaging tests, consultations, and examinations before your surgery, your pre-surgery cost of care equals $3,000. Because you haven’t met your deductible, and based on the nature of the visits, none of these appointments qualify for copays, so you are responsible for paying the full $2,500 before you even make it to surgery. You are also responsible for paying $100 to meet the 20% coinsurance requirement for the remaining $500.

Now that your deductible has been met, you are responsible for the 20% coinsurance for the surgical procedure. If the surgery costs $8,000, you now owe an additional $1,600 for the surgery. **This brings your current out-of-pocket total to $4,200. **After your surgery, let’s assume you have several follow up appointments and physical therapy sessions that total $2,000. Luckily, you only have to make copayments on these visits because follow up services and rehabilitation are covered by your policy. So, for the 10 appointments, you are only required to pay a $50 copay for each, or $500 total.

Example out-of-pocket cost of a torn ACL with health insurance.
Example out-of-pocket cost of a torn ACL with health insurance.

Adding up your out-of-pocket expenses, you have now paid $2,500 for your deductible, $1,700 for your coinsurance, and $500 in copays.** This means that the total out-of-pocket medical expenses for your accident, assuming your insurance company covered all of the services performed, were $4,700.** Phew.

Even if you have health insurance, an accident can still set you back financially. In addition to the out-of-pocket costs for your injuries outlined above, there are several additional expenses that are often overlooked. Check out the third, and final, part of our series for some of those common, indirect expenses incurred when you have an accident.

Read Part 3

See how Buddy’s accident coverage can fit with your health insurance here.