Subrogation by Health Insurance Company

Question: My son was involved in a car accident about a year ago. The driver of the car he was in was found negligent. My son has had several medical bills related to this accident. Originally, when my hospitalization company received bills for medical treatment, they sent me a notice inquiring about the accident. They have paid the majority of the bills. My question is, can my hospitalization company come after me for the amount they have paid?

Answer:

Your contract/insurance plan does give your health insurance company a right of subrogation. This means that, if your son does recover money from a third party, he is obligated to repay the money to the health insurance company for the bills they paid.

Even if you must repay the health insurance company, we believe you are still better off having your health insurance company pay the bills. If you pay the provider directly or if you have the car insurance company pay the medical provider directly, you will be paying 100% of the bills. The health insurance company has negotiated a contract with the provider and will pay less than 100%. You pay for health insurance and should take advantage of this contract. Then, when you repay the health insurance company, you are getting the advantage of the insurance company’s discount.

You should also be aware that your son does have his own claim for pain and suffering against the car insurance company. The amount of money that you son is entitled to is, of course, dependent upon the nature and extent of his injuries. Since he was obviously injured enough to secure medical treatment, he was, therefore, injured enough to make his own claim for these personal injuries to the car insurance company.

You should consult with an attorney so that you can make an intelligent decision as to whether or not you should proceed with your son’s claim against the insurance company or what amount would be a fair settlement with the insurance company. Contact our office for further information, a free consultation, or representation, and we will be glad to give you our personal attention, or your may visit our website at sternbergandzeid.com or e-mail us at sternbergzeid@ameritech.net .

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