You might have to reimburse your health insurance company in a personal injury case. This is because Illinois law allows for healthcare subrogation. Healthcare subrogation is a right that health insurance carriers have to be reimbursed from a personal injury case. Reimbursement is for money which they paid for 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 person who they insure is able to recover the cost of that bill from the person responsible for causing the injury, 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.
How much money do I have to reimburse my health insurance company?
Don’t worry, you do not have to pay back the full amount of the medical bill. Remember, 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 of any kind 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.
Your attorney will attempt to further reduce that 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 and pay for 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, while reaping the rewards. 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.
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, after all, they don’t want to have to get paid a discount if they can help it. Tell them it goes through your health insurance.
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. Give us a call to see how we can help with this, so that you can focus on getting better.