Guidance on Managing Health Insurance Subrogation After My Pregnant Wife’s Car Accident (Texas)
My pregnant wife (37 weeks) and I experienced a minor car accident in a parking lot. After consulting with our doctor, we were advised to go to the hospital for further checks on the baby. Fortunately, both mother and baby are healthy, although my wife was admitted for labor induction due to unrelated medical issues.
The hospital bill has arrived, and I estimate around $6,000 of it pertains to the Emergency Department expenses solely from the tests and procedures to ensure the baby was okay after the accident. The total costs amount to roughly $20,000. Thankfully, my health insurance covered most of the expenses, with the exception of my $7,000 deductible.
The other driver’s insurance has taken full responsibility for the accident and is already processing the repairs for my vehicle. I plan to settle with them to cover the medical bills and need to account for lost wages from taking additional time off work to manage this situation.
I’m seeking advice on how to navigate the subrogation process with my health insurance. Should I simply inform them of the situation and ask for the amount they believe they are owed, then settle and pay them their share? Am I allowed to retain my deductible before settling with them? How does the entire process work?
I’ve consulted with some attorneys, but my case is considered too small for formal representation. My goal isn’t to seek a significant payout; rather, I want to ensure I understand how to work effectively with my health insurance and distribute the settlement funds appropriately.
Thank you for your help!
I’m sorry to hear about your situation; it sounds very stressful, but it’s good to know that both your wife and baby are healthy. When it comes to handling health insurance subrogation in Texas, here are some steps you can follow:
Contact Your Health Insurance Provider: Inform them about the accident and that the other party’s insurance is responsible. They will usually have a dedicated subrogation department that can guide you through the process.
Gather Documentation: Compile all medical bills, proof of payments, and documentation related to your deductible. This will help you understand the total amount your health insurance paid and what they might claim in subrogation.
Understand Subrogation Amounts: Your health insurance should inform you how much they’ve paid on your behalf. In many cases, they will have the right to seek reimbursement from any settlement you receive from the at-fault party’s insurance.
Deductible Considerations: Typically, if your health insurance paid for the medical bills, they might be entitled to recover their full amount from the at-fault party’s insurer. You should check with your health insurance provider to clarify whether your deductible can be deducted from the amount owed to them before you settle with the other insurance company.
Communicate with the Other Party’s Insurance: As you negotiate your settlement, be transparent about the amounts owed to your health insurance. They may need to confirm their right to subrogation with the other insurance company.
Settlement Amount: Once you finalize a settlement with the at-fault party’s insurance, let your health insurance know before you disperse any payments. They will advise you on how their portion should be handled.
Keep Track of Everything: Document all communications, amounts paid, and correspondence with both insurers. This will help you keep a clear record of the process.
Consider Additional Damages: Since you lost wages, you might also want to ensure that these are included in your settlement negotiations. Make sure to document any lost income as part of your claim.
Doing this on your own can be complex, but as long as you maintain organized records and communicate clearly with all parties, you can navigate the process successfully. If you find it overwhelming at any point, consider consulting a personal injury attorney for advice, even if your case is relatively small. Good luck!