Medical Bills: subrogation statute of limitation

Posted: Wed Apr 14, 2010 06:11 pm Post Subject: Subrogating: 3 health insurance plans later

On 1/28/05 my daughter had an accident, losing her leg. She had an independent CIGNA health plan. After over a year of battling, CIGNA paid & finally signed of on the bills as contracted. Then we switched to another insurance plan through my work for 2 years, having my daughter as a dependent. On 10/1/08 United Health Plan became my insurance company from work, my daughter being a dependent. She's gotten a new foot and a same day easy surgery. Ingenix wants to subrogate for United and wants our and the other party's insurance company info. with a claim on any settlement. Can United, 2 health plans removed from the accident, have a claim here? Wouldn't her condition be a pre-existing condition, as far as United is concerned.
Lei

Posted: Wed Apr 21, 2010 01:16 pm Post Subject: Statue of Limitation

I was in a car accident summer 1995, totaling my van, which was only a month old. A rental company did a poor job installing the hitch, which caused my van to flip over. In the end, the only money I collected was $15,000 for a $28,000 van, and was told that the insurance company was only responsible for the shell of the van, as if you can buy one without seats, etc.

I got treatment from a chiropractor doctor for pains, totaling over $400 and advised them the I lost so much, having the pay off the $10,000 plus difference for the van, and get another car. I though I had resolved this with the doctor but on a very few occasions I received a bill, which I thought was a routine error. Then, about 13 plus years later, a few weeks ago (2010), I received a letter from a collection attorney and a threat of a judgment against me. I called the attorney and we verbally agreed to my paying $75 per month to satisfy the problem and he advised me that he would get that in mail to me, which I never received. Instead the judgment was interred in the Court last Monday (April 12 or 13), 9 days ago (including weekend days) and after calling the attorney every day to deal with the matter and his not returning the calls, he finally called yesterday afternoon and rudely told me that he was not my attorney and did not owe me any advise.

My question: Is there a Statue of Limitation on such a case as mine and should I have to pay this bill and suffer the judgment on my Credit Record for some 7 years? Please advise ASAP, as I have such a short window to have this judgment set aside, with a total of twice as much with court and attorney fees, interest, etc. I this fair and can I get this resolved without all this, which they want immediately if I hope to have the judgment set aside. I do not have the money.

Thanks,

Kley

Posted: Thu Apr 22, 2010 10:26 am Post Subject:

I doubt a judge would enter a judgement if the statute had ran. However, that being said, if you have a copy of the judgement..look at the dates of service and verify they are correct.

Posted: Fri Apr 23, 2010 04:12 am Post Subject: Subrogation s.o.l.

I was in a auto wreck last year and spent some time in the hospital and some other treatment. My health insurance paid most everything upfront. I did get a settlement from the auto insurance. So far my health insurance co has not subrogated and it's been over a year.

How long do they have to come after the settlement if they so choose to do? Would they take a lesser amount as my settlement amount was a little less than the total of all the bills?
Thanks!!

Posted: Thu Jun 17, 2010 12:03 pm Post Subject: medical bills

2004 had a judgement against in for a medical bill paid lawyer in 2004, and checked it was deleted from my credit report just today got a letter from same lawyer that i still owe money on this claim

Posted: Thu Jun 17, 2010 12:54 pm Post Subject:

Do you have anything in writing indicating that you paid the bill in 2004? Do you have a copy of the cancelled check you paid the bill with?

If there was a judgment entered against you, and you satisfied the judgment, there should have been a "Satisfaction of Judgment" or similar "notice" paper filed with the court.

Ordinarily, if no other collection efforts have been made against this amount claimed as owed since then, this bill would be uncollectable. However, because it is the result of a judgment, different "rules" apply.

To properly preserve your rights under the Fair Debt Collection Practices Act, you must respond IN WRITING (mail certified, return receipt) to the collection letter you received within 30 days -- a telephone call is insufficient, and failure to respond is considered a rebuttable acknowledgment of the debt. In the letter you send, you would want to dispute the debt and demand verification. You should also indicate in that letter that you paid this same lawyer the full amount in 2004 (or whenever you actually paid it) and that you want to know why you are being harassed years later.

Upon receipt of your letter, the FDCPA requires that they respond to you in a timely manner, providing the information you requested, or indicating that they are dropping the matter or pursuing a different course. Be sure to keep copies of everything from this point . . . the letter you received, the letter you send (you can fax the letter, but must still mail a hard copy), and response you receive. [[Nothing prevents them from saying they never got your letter, so faxing and sending via trackable mail delivery (certified, return receipt) is your documented version of the truth.]]

If you still live close to the court where the judgment was obtained against you, you should go to the Clerk of the Court, have them pull the file, and look through it to see if the Notice of Satisfaction of Judgment (or Release of Judgment Debtor) was ever filed as required. You should have received a copy of anything filed with the court.

If you cannot come up with your documentation showing that you paid the judgment amount, you could easily have to pay it again. That would be a painful lesson in recordkeeping.

Posted: Mon Oct 04, 2010 05:29 am Post Subject: Health Insureance

I live in Arizona and was hit by a hit and run driver on my motorcycle in April. My medical insurance paid my medical Bills minus co-pays and deductibles. I got a settlement for bodily injury under my Uninsured motorist on my motorcycle policy in June. I now get a letter from the medical insurance stating that I have to pay them back what they paid. Is this legal??

Posted: Mon Oct 04, 2010 07:06 am Post Subject:

Tom . . .

Like many other insureds in similar situations, you are the unfortunate "victim" of a standard provision in your medical AND auto/motorcycle insurance policies known as SUBROGATION. However, when you state "there was no third party involved" you are mistaken. The hit-and-run driver IS, indeed, the third party. That he/she is unknown makes no difference.

Subrogation allows an insurance company to recover its "first-party" claims payments resulting from the negligence of an at-fault third party. If you had crashed your motorcycle as a "solo" event, and your medical bills were paid by you medical insurance policy, but you also received "medical payments" for the same expenses by your auto/motocycle policy, the medical insurer would still be entitled to recover. If you, separately, obtained a judgment from the third party for the same expenses, then both the medical and auto/motorcycle insurers would press their claims for subrogation.

It's very common for either medical or auto insurance companies to sit back and let persons such as yourself obtain a settlement and then swoop in making a claim for 100% of their expenditures on your behalf. That way they don't have to expend any money for lawyers to do the work. They have the contract language firmly on their side.

I first learned this about six or seven years before I found my way into the insurance industry, following my dad's nearly fatal traffic collision. He was covered by workers' compensation, and was hospitalized at a Kaiser hospital (he had Kaiser insurance) with broken legs, a broken arm, multiple lacerations, and suffered a stress-related mild heart attack a few days after the collision (at least he was in the hospital). His auto insurance company was the same as that of the at-fault driver.

There were no witnesses named on the police report, but a "surprise" defense witness appeared at the last minute who happened to be a personal friend of the vehicle owner (the driver was an illegal alien who fled back to Mexico and was never located) who claimed he saw the accident happen and that it was my dad's fault. Threw the lawyers into a panic and they settled for about $50,000.

But they completely overlooked the subrogation issue. My dad's employer's WC carrier stepped up to claim the wages it had paid, Kaiser stepped up to claim its medical expenses, only they realized that it was a WC claim, so they actually tapped the WC carrier for those, and then the WC carrier added that to their demand.

Well, the lawyers took their 33% off the top. The WC carrier agreed to limit its claim to 33% of the settlement (about 40% of their expenditures), leaving my dad with about $17,000 for his troubles. He could have gotten twice that much from the insurance company on his own, and had them pay the hospital and WC subrogation separately.

What you need to do is try to work out a compromise with the medical insurance company. Explain to them that you were unaware that they were going to be entitled to recover any money from your settlement and that you, naturally, used the money to pay other bills that piled up as a result of the accident. Get them to agree to reduce the amount they are seeking, and to allow you to make payments.

Now, it also sounds like your insurance is a group policy. You would probably have never seen the "Master Contract" that contains the subrogation provision, and it probably is not disclosed in the "outline of coverage" you may have been given. If that's true, then you have a different way to get them to leave you alone. You can argue with them that they should have given you notice that, due to the nature of your accident involving a third party, if you recovered any money from your or any other insurance company, they would be entitled to up to 100% of the claims they paid on your behalf, and provide you with a statement of their claim (a $$ amount).

Did they furnish any itemized billing statement ("explanation of benefits") prior to making their subrogation demand? If they did not, you could argue that they intentionally concealed their intent to subrogate, and had you known, you would not have settled for an amount that did not include payment of their claim directly to them.

The person you want to discuss this with at the medical insurance company is a senior claims dept supervisor -- definitely not the person who's name is on the subrogation letter they sent, but someone above that person who has the authority to make decisions.

Arizona has a program similar to California's "Victims of Violent Crime" financial assistance program. Since a hit-and-run traffic collision with injuries is prosecutable as a felony in most states, it would qualify as a "violent crime", and you could obtain assistance with paying medical bills through the program, assigning the money directly to the insurance company. Information about the program can be found at http://www.acjc.state.az.us/ACJC.Web/victim/VictComp.aspx

It might be an answer to your "new" problem. The compensation limit is $20,000, so if your medical expenses exceed that, you could try to get the insurer to agree to accept whatever the state awards you. Typically, programs like these try to award as much to a victim as can be documented -- medical expenses, lost wages, unpaid personal expenses -- almost anything other than lawyers' fees, property losses, and "pain and suffering". However, they do state that your award could be reduced if you "recouped the economic loss from a collateral source," which is what your auto/motorcycle insurance has done.

Because of that, I'm not sure you would qualify for that benefit. Give it all a shot. The worst that can happen is that they tell you, "No, you've already been compensated."

Posted: Thu May 19, 2011 12:36 am Post Subject: collection

Medical Insurance:
Two common mistakes: 1) Thinking that your insurance company is responsible for paying your medical bills and, 2) Thinking medical providers are required to bill your insurance company.

The truth is, consumers are responsible for their own medical debts. This means consumers must ensure their insurance company is billed in a timely manner and billed correctly. It also means they must follow up in a timely manner to ensure the medical bill gets paid.

As a convenience for you, most medical providers will offer to bill your insurance company. Accepting their offer does not relieve you of the responsibility of ensuring the medical bill gets paid. It's not uncommon for medical providers to submit medical bills after an insurance company's deadline for filing. In some cases, the provider may, for a number of odd reasons, not submit the medical bill at all. Regardless of the reason, the bottom line is that the consumer is still responsible for paying off the medical debt.

In some cases, your insurance company may reject the bill or flat out refuse to pay. If this happens, the medical provider will expect you to pay the bill and, unless you've disputed the debt, you are legally expected to pay the bill in a timely manner. The fact that your insurance company did not pay is not the medical provider's concern! You may have to argue with your insurance company or go through dispute resolution but, the medical provider is entitled to timely payment. You may have to pay the provider yourself and then work with your insurance company to get reimbursed.

Always read the medical provider paperwork (contract for services rendered) carefully!

Medical Bill Disputes:
Medical bills and old medical debts that you consider invalid can be disputed just like any other debt.
Disputing Medical Debts

Just like any debt, interest can be added to medical bills IF the original contract or paperwork allows it AND your state law does not prohibit it. Even if the original paperwork allows it, ALWAYS check your state law to make sure you are not being overcharged. Some states limit the amount of interest and the amount of collection fees.

Posted: Sat Jan 07, 2012 03:37 am Post Subject: Unpaid bill

I live in VA, am retired military, had an accident in 2007, gave the doctor my medical insurance and additional insurance company info, just received a letter from a collection agency for over $800.00. After making a few calls including the collection agency, the answers I received were that the doctor had inexperienced help and they did not send their bill to my insurance. Now, after all this time am I required to pay them? It certainly wasn't my fault. Appreciate your help. We're talking years!!