Health / Auto Insurance subrogation

by RSDlap » Thu Dec 04, 2008 10:24 pm
Posts: 1
Joined: 04 Dec 2008

I live in Oklahoma and was at fault in an auto accident about 3 years ago. I was hospitalized and my health insurance covered the hospital bills (minus deductibles and coinsurance). My auto insurance company also sent me a check for my full amount of med pay coverage without asking any questions about my treatment, bills, or other coverage. Just yesterday, I received a letter from my health insurance company stating that I owe them any amount paid through settlement or award from another source and that they are aware of another amount paid.

Am I responsible for paying my health insurance company the amount my auto insurance company paid me? Can I at least substract the deductibles, coinsurance, and other (dental) bills I paid out of pocket?

Thanks

Total Comments: 25

Posted: Fri Dec 05, 2008 12:49 am Post Subject:

I live in Oklahoma and was at fault in an auto accident about 3 years ago. I was hospitalized and my health insurance covered the hospital bills (minus deductibles and coinsurance). My auto insurance company also sent me a check for my full amount of med pay coverage without asking any questions about my treatment, bills, or other coverage. Just yesterday, I received a letter from my health insurance company stating that I owe them any amount paid through settlement or award from another source and that they are aware of another amount paid.



Great question. The simple answer is "yes, you do."

Your health insurance carrier is legally entitled to receive what they have paid towards your medical expenses from any source (other than you) which may pay towards the loss.

In this case, your automobile insurance company simply forwarded to you the coverage maximum payable under your automobile medical payments. This is more than likely due to the fact that your incurred medical bills far outstripped the maximum coverage under the automobile med pay, and the insurer simply sent you a check for "policy limits" after they reviewed the medical bills.

Your health insurance company, by seeking repayment of the expenses that they paid, is "subrogating" the loss. This is fancy legal terminology that refers to the idea that insurance companies look for reimbursement from any other policy or person that's legally responsible. As an example, if you were NOT at fault in this accident, and your health insurance paid for your injuries, the health insurance company would now "subrogate" against the other guy's car insurance to recover the money that they paid you. If the other guy wasn't insured, they would go after him personally.

This is a practice that's done everyday in the industry- it just happens behind the scenes and is something that the average consumer knows little about.

InsTeacher 8)

Posted: Fri Dec 05, 2008 10:01 am Post Subject:

Just asking to clear my confusion… as far I know Medpay pays your bills upfront and then subrogate the other insurer or the health insurer. Health coverage, normally, plays the supporting role in such situations and kicks-in after the Medpay limit exhausts itself. I'm finding the OPs situation somewhat reverse.

Can someone help me clarify?

Posted: Fri Dec 05, 2008 10:36 am Post Subject:

as far I know Medpay pays your bills upfront and then subrogate the other insurer or the health insurer

No, actually in a lot of states medpay is non-subrogatable...

Health coverage, normally, plays the supporting role in such situations and kicks-in after the Medpay limit exhausts itself. I'm finding the OPs situation somewhat reverse.

Actually it's just who gets and pays the bills first...in this case the health carrier did, so they have subro rights against any and all monies received for this treatment...had it been the other way around...say his total cost of treatment was 15k and medpay jumped in and paid their 5k limit then his carrier would've only had to pay 10k...health carrier in ALL situations i've ever seen will be secondary and subro any payment under their policy if there is another carrier involved...that's why they send a letter to you after certain treatments (x rays for example) asking if the injury was caused by someone else or if there is another carrier consider the bills.

Posted: Mon Jan 12, 2009 09:38 pm Post Subject: deductibles for health insurance re subrogation

I work at a Health Insurance Company in Missouri, I am in charge of collecting money for our subrogation issues. I understand that what we paid out for the member is reimbursed to us by the third party, but can the member hold the third party responsible for their deductible and out of pocket expenses?

Posted: Tue Jan 13, 2009 01:31 am Post Subject:

I understand that what we paid out for the member is reimbursed to us by the third party, but can the member hold the third party responsible for their deductible and out of pocket expenses?

Absolutely...this should be included in their 'specials' (actual bills) when settlement time arrives...

Posted: Tue Jan 13, 2009 02:05 am Post Subject:

Usually won't your health insurance settle for a lesser amount? My bills really got up there but I found out they are not asking for the full amount. If this is so will I have to worry about them coming back for more repayment later? They were sent a letter asking if the were going to want paid back (sure there is a name for this form) and it was done recently. They only requested a fraction of the cost.

Posted: Tue Jan 13, 2009 07:09 am Post Subject:

but can the member hold the third party responsible for their deductible and out of pocket expenses?



The member would certainly get reimbursed for the deductibles paid by him/her if the third party is responsible for causing the injuries.

Fiery, I don't think that the provider would come after you to get more payments in the future. The subrogation would be negotiated between the two coverage providers and you are no longer involved in it. Hence, you need not to fear that the medpay provider would come after your assets in the future.

Posted: Tue Jan 13, 2009 11:31 am Post Subject:

Fire if they only requested a fraction then that's all they will ask for...all carriers (health) are different...health carriers don't pay as much for services as joe blow walking in off the street does...from most (if not all) vendors

Posted: Tue Jan 13, 2009 02:59 pm Post Subject:

Thats good. It made me a little nervous there. What I can't figure out and wasn't going to question is why they paid sooo much and are only asking for so little. I guess I should not look a gift horse in the mouth right?

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