The fast answer – yes, you have to give them this information. Here is why.
When your health insurer pays a medical bill for injuries caused by someone else, it gets the right to be paid back by whoever caused the accident – or by their insurance company. This is called subrogation.
Let’s say you’re in a car wreck caused by John Smith and you need spine surgery. You have health insurance with Anthem.
Anthem pays for your spine surgery; this gives Anthem the right to recover its payments from John Smith, or his insurance Company, State Farm – or from you. That is why Anthem wants the information – so it can make sure that State Farm reimburses it.
And your policy with Anthem requires you to cooperate in its attempts to recover its payments. In fact, your policy with Anthem also requires you to make sure Anthem is paid back out of any settlement.
That is why you have to tell Anthem pretty much whatever they want to know.Here’s how it works.
Let’s say State Farm is willing to pay $150,000.00 to settle your case. But it wants to make sure that Anthem – which has paid $53,000.00 in medical bills – is paid off as part of the deal. (Otherwise, Anthem may sue State Farm, or the person it insures.)
As your attorney, my goal is to get you as much as possible out of the deal.So I call the Anthem representative, and – after some negotiation – we agree that they will accept $38,000.00 to settle their claim.
(So you know, I made the numbers up. Anthem may agree to accept more or less – it depends on a lot of different factors.)
When State Farm pays off, they will probably send two checks – one payable to you and me for $112,000.00, and the other payable to you, me and Anthem for $38,000.00.
Over the years, there have been a lot of lawsuits over the right of the health insurance company to collect its money. But this is the way it usually works out – they don’t want to pay a lawyer to get their money back, you don’t want to be tied up in a lawsuit with Anthem, and no one wants the delay.
I have been a lawyer over 30 years. I have been negotiating with health insurance companies over payments that entire time. If you want to know how much your case can settle for and when, speak with a Lawyer – call me at no charge at 513-621-4775.
Because all situations are different, and because there may be other facts pertaining to your case that I don’t know about, you should not rely on this answer for legal advice. I am not your attorney, and no lawyer client relationship has been formed.
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