Detailed Answer
Under Missouri law, there is no provision like North Carolina’s Rule 414 that lets an insurance adjuster unilaterally reduce your medical bills. Missouri Supreme Court Rule 55 (Character Evidence; Sexual Misconduct) does not apply to civil claims or billing disputes. Instead, Missouri uses the “collateral source rule” to ensure you recover the full amount of your medical expenses regardless of payments you receive from health insurers, Medicare, or other benefit plans.
Missouri Collateral Source Rule
Mo. Rev. Stat. § 490.715 (link) prohibits a defendant or insurer from using collateral payments to reduce the damages they owe you. In other words, if your health plan pays $5,000 of a $10,000 medical bill, a defendant cannot argue they only owe you $5,000 at trial. You remain entitled to prove the full $10,000 in damages.
Negotiated Rates and Provider Agreements
Although adjusters often negotiate settlements based on discounted provider rates, they cannot force a discount without the provider’s consent. For example, in a workers’ compensation claim under Mo. Rev. Stat. § 287.150 (link), carriers pay statutorily defined fee schedules. In auto or general liability claims, any negotiated rate depends entirely on agreements between insurers and medical providers.
Subrogation Rights
If a provider accepts less than the billed amount, an insurer may exercise subrogation rights to recover that payment from your third-party settlement or judgment. This process does not reduce the gross amount of your medical expenses—it simply reallocates who collects the payment after you recover from the responsible party.
Helpful Hints
- Review your Explanation of Benefits to understand what your insurer and providers have paid.
- Keep all medical bills and EOBs organized by date and provider.
- Ask medical providers if they will accept a negotiated rate before you sign any assignment of benefits.
- Track any subrogation claims your insurer or health plan makes against your third-party recovery.
- Consult a Missouri personal injury attorney to understand how collateral source rules and subrogation may affect your case.
Disclaimer: This article is for informational purposes only and does not constitute legal advice. You should consult a qualified attorney in your jurisdiction for advice tailored to your situation.