Detailed Answer
This question arises from confusion over North Carolina’s Rule 414 and whether a Nevada insurer or adjuster may similarly slash your medical bills. North Carolina Rule 414 is an Evidence Rule concerning character evidence in sexual misconduct cases—and it does NOT authorize insurers to reduce medical charges. Nevada does NOT adopt an equivalent rule for billing reductions.
Under Nevada law, an insurance adjuster can only pay what your policy covers. They may negotiate with providers if the policy has a negotiated-rate network or outlines payment of “customary, usual and reasonable” (C&R) charges. But they cannot unilaterally declare your full medical bills invalid or force providers to write off fees beyond what the policy allows.
Key statutes and principles:
- NRS 41A.070 (Collateral Source Offsets): This statute lets insurers subtract payments from other sources when calculating damages. It does not let insurers reduce what providers billed you. NRS 41A.070.
- Reasonable, Usual & Customary (C&R) Charges: Many policies limit payment to C&R amounts. Adjusters may rely on a database or internal guidelines to determine that amount, but they pay only what the policy promises—not the provider’s full billed amount.
- Network Agreements: If you visit an in-network provider, the provider has contractually agreed to accept the insurer’s negotiated rates. An adjuster will pay that contracted amount, which is often lower than billed charges.
If your policy includes medical payments coverage or personal injury protection (PIP), the insurer pays only up to your policy limit. After that, any unpaid bills remain your responsibility unless you negotiate separately with your provider.
Overall, no Nevada rule equivalent to NC Rule 414 empowers an adjuster to cancel or reduce billed medical fees outside your policy terms. They can only pay according to policy limits, network agreements, or C&R guidelines under Nevada law.
Disclaimer: This article is for general informational purposes and does not constitute legal advice. Consult a licensed Nevada attorney for advice on your specific situation.
Helpful Hints
- Review your policy terms: Check limits, network clauses, and definitions of C&R charges.
- Ask for an itemized bill: Understand each service and identify areas for negotiation.
- Negotiate directly: Contact your medical provider to request a discount or payment plan.
- Check provider networks: In-network providers often accept lower rates—verify your coverage.
- Consult an attorney: If your insurer denies or underpays benefits, get legal guidance.