Wednesday, March 7, 2012

What law in prevents health insurance companys from subrogating paid medical bills?

I live in Pennsylvania and I need to know what law prevents insurance company from subrogating medical bills paid out from a motor vehicle accident.



I know there is such law because my lawyer used it for me, my friend would benefit from that law but I cannot remember what it was.



Please provide a link to a official page on it.What law in prevents health insurance companys from subrogating paid medical bills?
I'm not aware of any such law.



If your attorney used it - call him and ask him about it.



But each situation is unique. Just because a health insurer did not subro in your case does not mean they can't do it in your friends case.



If your friend has an ERISA (employer sponsor) health plan. The plan has language in it that will allow the health insurer to subrogate against the settlement proceeds. This is how health insurance keep their rates down. If they did not subro - health insurance rates would be higher than they already are.



Medicare, Medicaid, Tri-Care automatically have a lien. Can't get around not paying those guys.



It could also depend on the coverage the claim is being made under. In some states, you can't subro against certain coverages.



It can get tricky dealing with health insurance liens. And there can be lots of different variables that affect it.What law in prevents health insurance companys from subrogating paid medical bills?
Why don't you contact your attorney and ask him? That would certainly be the easiest way to get the information. Or look in the copies of any records you have from your case.



But be forewarned that you may have had unique circumstances that don't apply to your friend's situation.



There are no laws that I'm aware of which prevent subrogation. In fact, subrogation is a fairly common thing.



Your state may have specific laws limiting the circumstances under which subrogation can occur...if that's the case, you'll have to get that information from your attorney. Or your friend will have to get his/her own attorney.



The health insurance policy should specifically spell out a section regarding subrogation as well. Since the health insurance policy is a legally binding contract between you (or your friend) and the insurance company, all rules spelled out regarding subrogation would have to be followed. Your friend should check his/her insurance policy's section regarding subrogation as well. (Or have his/her attorney review the information.)What law in prevents health insurance companys from subrogating paid medical bills?
Well, in pa, the law says, the health insurer can subrogate against the auto insurer - and the reverse, as well.



I've seen pa claims subrogated in BOTH directions - HOWEVER, if there is an auto related injury, the AUTO policy is primary - that means, the auto carrier can't ask the health insurer for reimbursement. In some cases, I've seen the health insurer flat out decline to pay the auto injury - it's based on how the health insurance policy is written, which makes it CONTRACT LAW.



You need to go to state auto law.

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