by Guest » Fri Feb 13, 2009 06:13 pm
I have private insurance with a deductible and out of pocket max of 2K.
My health ins company was paid back 5K in subro after a settlement. I then had unrelated medical needs and have been paying the out of pocket expenses and deductible. Is the 5K paid back to them through subro go toward my deductible and out of pocket max?
My health ins company was paid back 5K in subro after a settlement. I then had unrelated medical needs and have been paying the out of pocket expenses and deductible. Is the 5K paid back to them through subro go toward my deductible and out of pocket max?
Posted: Fri Feb 13, 2009 06:36 pm Post Subject:
yes subrogation is now the known phenomenon in health industry.(read
about "Walter vs. Hormel", 120 F.3d 138 case) the injured person was paid
under the ERISA health insurance plan. i won't think those 5 K will go
towards deductible. :wink:
Posted: Fri Feb 13, 2009 07:48 pm Post Subject:
I'd say its a good possiblity that the health carrier won't apply it back to anything. I just don't know if their accounting would be that good.
I'd say it should be paid back in reserves order. So it would go toward your out of pocket and then your deductible. But that is just a guess.
Posted: Sat Feb 14, 2009 03:24 am Post Subject:
I guess I'm kind of wondering a couple of things here...
My health ins company was paid back 5K in subro after a settlement.
That leads me to think that you had a claim and they paid out medical expenses on your behalf, and they went after the responsible party through subro and recovered some bucks. Next step would be that since you had that claim- you had to fork out the deductible before the insurer would pay anything. Assuming that's correct, you then said that
I then had unrelated medical needs and have been paying the out of pocket expenses and deductible.
This makes me think of a couple of things:
1. The claims occurred in separate plan years (first claim w/subro in one plan year and the unrelated expenses in a different plan year). This could easily lead to another deductible. Check to see if your policy has a "carryover" provision that applies to the deductible.
2. You have a "per occurrence" deductible as opposed to a "calendar year" or "cumulative" deductible. This is kind of rare, and usually associated with Medicare Part A
So, it looks like we need some more info to get you the right info back!
BTW- most states have laws that require insurers, in the event of successful subrogation, to pay the insured his deductible back first when they get the bucks. You might have something there, too.
InsTeacher 8)
Posted: Sat Feb 14, 2009 05:13 am Post Subject:
Hi OP
I do not think this subrogation amount will go towards your deductible. The insurance company is allowed the right to pay you for the loss that you have incurred and then pursue the responsible party for the payments that they have made to you.
Posted: Mon Feb 16, 2009 02:14 pm Post Subject:
Hi..even I wouldn't believe that this amount would come to your help!
It was quite natural for you to pay for the deductible as per your agreement.
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