Legal Advice Needed Re: Health Insurance *DELETED*

[ClearenceMumford]

Post deleted by ClearenceMumford

 

[TxStHorn]

Generally speaking (it all depends on the individual language of your particular policy, and the type of plan you have [i.e., if it's a true ERISA Plan (many proclaim to be, but actually are not), then this advice will be different])

Your health insurance has a RIGHT to subrogate against proceeds you receive from a third party (another person/entity that caused your injury) for payments made by your insurance company for those injuries.

In other words, they have a right to be paid back out of YOUR settlement/jury award whatever amounts they paid for your treatment.

With a typical health insurance policy, however, this right is NOT absolute. They have to formally notify you of their intention to initiate thier right to subrogate, and they have to do it BEFORE any funds you have collected from the 3rd party are distributed.

In other words, while your HI has the right to subrogate, if 1) they paid for your injuries, but never notified you that they intend to subrogate, 2) you receive funds from the third party for those injuries, and the funds are distributed (check cashed, you get your $, your attorney gets his fees, etc)., and the 3) the very next day your HI calls and says "by the way, we want to be paid back," then you HI is out of luck - they failed to formally notify you in a timely manner.

If you have made no claims against a third party, and are not going to (whether you could or not isn't the issue) then whoever is contacting you can also stick it. There is nothing to which their subrogation right attaches, so you owe them nothing.

They also generally have no right to recover against your own insurance - i.e., if you were in a car wreck, and collected any money on your own policy of auto insurance (uninsured/underinsured coverage, or Personal Injury Protection/PIP, etc.).

Again, of course, this is is general law, and can vary greatly depending upon the type of coverage you had.

Feel free to PM me if you have any other questions.

 

[Summerof79]

What the poster above said. If you were ina car accident they would go after the other driver's insurance to pay for the procedures. If you had received $20 grand for injuries and then later they paid for a procedure related to the injury, they would probably be legally entitled potentially to part of the money.

not an attorney...

 

[B]

Are you covered by another insurance plan, such as your spouse's? If so, they could be trying to establish a coordination of benefits between the two plans.

 

[scottsins]

tell them that you are against lawsuits, because there is too much litigation, and didn't want to recover from a responsible party.

* of course if this is not true and you did get $, then you will just have to pay them back.