Medical Expense Recovery Calculator - Recover Your Out-of-Pocket Costs
Determine the amount you can recover for medical expenses after insurance coverage.
Potential Recovery Amount
Formula: Recovery Amount = Total Medical Expenses - Insurance Coverage. If insurance paid more than your total, your recovery is $0.
Disclaimer: This tool provides an estimate for educational purposes only. Actual recovery amounts depend on your insurance policy terms and applicable laws.
How to Use This Medical Expense Recovery Calculator
- Enter your total medical expenses — Include all bills: ER visits, hospital stays, surgeries, physical therapy, medications, medical equipment, and follow-up appointments.
- Enter your insurance coverage — Add up everything your insurance has already paid or will pay toward these expenses.
- Click Calculate — The calculator shows your remaining out-of-pocket medical costs that may be recoverable through a claim or settlement.
Understanding Your Medical Recovery Estimate
This calculator shows your unreimbursed medical expenses — the gap between what you owe and what insurance covers. Important considerations:
- Future medical costs: This calculator only shows current expenses. Add estimated future treatment costs for a complete picture.
- Medicare/Medicaid liens: If government insurance paid your bills, they may have a lien on your settlement for reimbursement.
- Health insurance subrogation: Your health insurer may seek reimbursement from your settlement for amounts they paid.
- Negotiated rates: Insurance companies pay negotiated (lower) rates — your "total" should reflect the actual amount billed, not the sticker price.
Frequently Asked Questions
What medical expenses can I include?
Include all reasonable medical expenses related to your injury: ambulance services, ER visits, hospital stays, surgeries, doctor visits, physical therapy, chiropractic care, prescription medications, medical equipment (crutches, braces, wheelchairs), and estimated future medical treatment.
Can I recover future medical expenses?
Yes. If your doctor estimates that you'll need future medical treatment (ongoing therapy, additional surgeries, long-term medications), these can be included in your claim. A medical expert's written opinion on future treatment needs significantly strengthens your claim for future expenses.
Does health insurance reimbursement reduce my settlement?
In many cases, your health insurer has subrogation rights — meaning they can seek reimbursement from your settlement for medical expenses they paid. However, the amount they can recover varies by state law and your policy terms. Some states limit subrogation to the net recovery after attorney fees.
What if my insurance denied my medical claim?
If your health insurance denied coverage for accident-related treatment, you can still include the full billed amount as part of your economic damages in a personal injury claim. However, some states have the "collateral source rule" which may limit what you can recover. Consult an attorney about your state's specific rules.
Understanding Insurance Recovery Rules
Your health insurer may have subrogation rights, meaning they can seek repayment from your settlement for medical bills they paid. However, many states cap subrogation at a percentage of your recovery. In some states, you only repay if you are fully compensated for all damages. Medicare and Medicaid liens are federally protected and must typically be repaid first from your settlement. Always review your insurance policy's subrogation clause or ask your attorney to handle lien negotiations.