You likely must reimburse your health insurance company as part of your personal injury case. This is because Illinois law allows for healthcare subrogation. Healthcare subrogation is a right that most health insurance carriers have, by law. This right allows them to be reimbursed from a personal injury case. Reimbursement is for money which they paid for your medical bills caused by an accident. Unlike an auto insurance company, the health insurance company won’t pursue reimbursement directly from the person who was responsible for an accident, but will place a lien on one’s injury case. The reasoning is that if the health insurance company paid a medical bill, but the injured person is able to recover the cost of that bill from the person responsible for causing the accident, then the health insurance company should be paid back. Otherwise, the injured person is receiving money to go towards a medical bill that was already paid.
Do I have to repay the full medical bill in my injury case?
You do not have to pay back the full value of services rendered, when your health insurance was given a discounted rate. When in-network, health insurance companies don’t pay the full bill to begin with. They have contracted rates. For example, if your doctor charges $300.00 for a service, this is the price that someone without insurance is expected to pay. But a particular health insurance company will have made an agreement with the provider to have a reduced price. So, let’s say that the $300.00 bill gets cut down to $175.00 . The health insurance company pays the $175.00 for you, and this is what the subrogation will be based upon, as a starting point. It would be very unfair if you had to reimburse the $300.00 charge if your insurance company only paid out $175.00.
Will my lawyer negotiate repayment to health insurance?
Your attorney will attempt to further reduce the amount that needs to be paid back. After all, the insurance company would not be reimbursed at all if it were not for your good decision to file a claim against the person who hurt you. In order to do that successfully, you probably had to hire a lawyer. It would be unfair for the health insurance company to just sit back and let you and your attorney do all of the work. This is understood. The “common fund doctrine” requires that health insurance carriers reduce their subrogation to take into account that you are paying an attorney. Your attorney will make sure that the health insurance company considers this. Your lawyer is also going to make sure that your health insurance company is only being reimbursed out of your settlement for injuries that were actually related to the accident.
An exception to negotiating down your repayment might happen with particular health plans. If your health insurance is governed by ERISA (a Federal law), you may need to pay back the full amount that your health insurance company paid out. Many larger corporations have ERISA health insurance plans.
Should I have bills submitted to health insurance?
Do not be upset over this right of subrogation. Remember, you will likely still want for your medical providers to submit the bill to your health insurance company! This will put more money in your pocket at the end and reduce the amount of your bills. Some providers will resist doing this, especially if they do not accept your health insurance. In those instances, they may wish to work on a healthcare lien, as another option.
If you were hurt in an accident that wasn’t your fault, don’t let concerns over repayment to an insurance company prevent you from doing what you need to do, either legally or in terms of seeking necessary medical care. Sorting out the financial aspects of an accident are what attorneys are for. If we end up working together, we provide all of our clients with in-depth guidance on how medical bills work in a personal injury case, including written materials in our client handbook.
Give us a call at 630 250-8813 and let us handle the legal side, so that you can focus on getting better.