Health Insurance Refusing to Pay? Here’s What You Should Know About Subrogation

Who Pays First?

After treating injuries from an accident, many people receive a notice from their health insurance company stating it may or may not be responsible for paying your bill. Many people think their health insurance company is refusing to pay. In reality, the health insurance company is explaining their right to subrogated interest.

What Is Subrogation?

When faced with mounting medical bills and an uncooperative health insurance company, many people don’t know what to do. The fact is your health insurance company has a duty to pay your medical bills according to your policy. But your insurance company might have a claim to subrogated interest. This means that they might have a right to reimbursement after they pay your claims. You still have a right to compensation for your losses. Your compensation, however, could be reduced by the subrogation claim your health insurance company has.

How Subrogation Works

If your health insurance company paid for $5,000 of medical bills for treatments for your injuries sustained in an accident, and you received $10,000 compensation from the liable party’s insurance company, your health insurance company could be entitled to reimbursement for the $5,000 paid.

Further Complications

This is a simplified example used to illustrate how the transfer of the right to compensation works. Additional factors that can affect subrogation include the difference between what the provider billed and what the insurance company ultimately paid. Also, the specific language in your insurance policy can affect how subrogation laws are applied in your case. Expect further complications if you have Medicare or are receiving workers’ comp benefits, both of which handle subrogation rights a little differently.

Insurance claims can be complex, especially when there are multiple policies involved. To ensure your medical bills are paid and you receive fair compensation for your losses, work with an Arlington Heights personal injury attorney when handling your claim. A skilled attorney can review your insurance policies and those of the liable party. Then, he or she can determine whether your insurer has a right to compensation and explain how that can affect your settlement.