Navigating Health Insurance Subrogation After My Pregnant Wife’s Car Accident (Texas)
My wife, who is 37 weeks pregnant, and I were involved in a minor fender bender in a parking lot recently. Following the incident, our doctor advised us to head to the hospital to ensure the baby was okay. Thankfully, both mother and baby are healthy. However, the hospital admitted her for childbirth induction due to unrelated health issues.
The initial hospital bill came in, and from my estimate, around $6,000 was incurred from the Emergency Department due to the necessary tests conducted for the baby after the accident. The total charges hovered around $20,000.
Fortunately, my health insurance has covered all expenses, minus my $7,000 deductible. The insurance company recognizes that the other driver was completely at fault, and their car insurance has taken responsibility, even covering the cost of my vehicle repairs. I’m planning to negotiate a settlement to cover the medical bills, and I also incurred lost wages due to taking extra time off work to deal with this situation.
I need some guidance on how to work with my health insurance regarding subrogation. Should I inform them about the accident, and will they tell me how much they’re owed? Do I need to retain my deductible amount before settling with them? How exactly does this process work?
I’ve spoken to a few attorneys, but my case seems too minor for them to take on. I just want to ensure I understand how to coordinate with my health insurance and distribute funds appropriately.
Any advice would be greatly appreciated! Thank you!
It sounds like you’re handling a complex situation, but with the right steps, you can navigate the subrogation process. Here’s a general outline of what to do:
Notify Your Health Insurance: Start by informing your health insurance provider about the accident and the fact that the other party has accepted responsibility. Be prepared to provide them with details of the incident and the medical care your wife received.
Understand Subrogation: Essentially, subrogation allows your health insurance to recover costs from the liable party’s insurance after they have paid for your medical expenses. Typically, they will be entitled to recover the amount they paid that is directly related to the accident.
Request a Subrogation Statement: Ask your health insurance for a detailed statement of what they covered in relation to the accident. This will provide clarity on how much they expect to recover.
Deductible Considerations: Generally, you are responsible for your deductible before the health insurance pays the rest. In most cases, you are allowed to keep your deductible amount, meaning when you settle with the at-fault party’s insurance, you should be reimbursed for the total medical expenses minus your deductible, provided that amount is included in your settlement.
Settlement Negotiation: When negotiating your settlement with the at-fault party’s insurance, ensure that you account for all your expenses, including medical bills and lost wages. Present the total (the hospital bills related to the incident) minus your deductible.
Distributing the Settlement: Once you settle, pay your health insurance the amount they claimed for subrogation. Make sure to keep documentation of all transactions for your records.
Consult with a Professional: Although you mentioned attorneys not being interested in your case due to the size, consider consulting with a financial advisor or another legal professional familiar with subrogation processes for your specific state laws. This can provide you additional guidance tailored to your situation.
Document Everything: Keep thorough records of all communications with your health insurance, the other driver’s insurance, and any related expenses. This documentation will be helpful if there are disputes later on.
Remember, the specific details of how subrogation works can vary by state and by your insurance policy, so always verify any procedures with your insurer directly. Good luck, and I hope you and your family continue to have a healthy and safe experience!