When I first started practicing law in the early 90s, a party who was injured in a car crash or due to someone else's negligence would be able to introduce the entire amount charged for their medical bills to the jury, regardless of any health insurance discounts. If the bill was $10,000, and the health insurer paid $2500, the patient paid $200, and the rest was written off due to health insurance discounts, the jury would only hear that the total bill was $10,000. The wisdom was that a negligent party should not be rewarded because the injured person paid for health insurance. The jury wasn't supposed to hear about "collateral sources" that might have assisted in paying or reducing the total bills. This concept was known as "The Collateral Source Rule."
Over the years, the Collateral Source Rule has been eroded in Missouri. In 2005, the Missouri legislature amended Section 490.715 RSMo. to include a new subsection 5, which stated that the presumed value of the medical bills a plaintiff can submit at trial is the amount necessary to satisfy the financial obligations on those bills. However, an injured party was allowed to "rebut" that presumption, through testimony or affidavits from medical providers, to show that the true value of the medical service was the total amount charged. In Deck v. Teasley, a 2010 Missouri Supreme Court case, the court held that if a plaintiff rebutted the presumption that the value of the medical services was the amount necessary to satisfy the financial obligation on those bills, then the jury could hear both numbers---the total amount of the bills charged, as well as the total amount necessary to satisfy those bills (after insurance discounts, etc.). In the above scenario, this meant that the jury would hear that the amount billed was $10,000, and the amount necessary to satisfy the financial obligations on those bills was $2700. Jurors were left to question which amount they should consider in rendering their jury verdict.
In 2017, the collateral source rule was eroded even further. Section 490.715 was amdended again--this time, to take out the rebuttable presumption that the amount necessary to satisfy the financial obligation was the value of the medical bills. The law now states that the only amount of the medical bills that the jury can hear is the actual cost of the medical care and treatment, which is defined as: “a sum of money not to exceed the dollar amounts paid by or on behalf of a plaintiff or a patient whose care is at issue plus any remaining dollar amount necessary to satisfy the financial obligation for medical care or treatment by a health care provider after adjustment for any contractual discounts, price reduction, or write-off by any person or entity.”
What does this mean? This means that a plaintiff who is responsible and carries health insurance could potentially have a less valuable case than a plaintiff who doesn't have health insurance and, instead, has a bunch of outstanding bills. That doesn't seem fair, I know.....but that's the law in Missouri here in 2018. In the above scenario, and under the current 2018 law, the jury would only hear that the value of the medical services is $2700.
So, if you are injured in a car crash in Missouri after August, 2017, and you are trying to settle your case, the other driver's insurance company isn't even going to consider the total amount of the medical bills you incurred. The insurance company will only consider the amount paid on those bills by you and your health insurer, as well as any amount outstanding on those bills. When we negotiate with insurance companies for our injured clients, they now want us to show them not only your bills, but also receipts for amounts you paid out of your pocket, as well as your health insurance explanation of benefits forms.
In other words, the collateral source rule is no longer much of a rule when it comes to medical bills in Missouri.