Lien Paid – Now Reversing EOBs
Last year, I was involved in a car accident and was advised to use my health insurance to cover my medical expenses until my case was resolved by an attorney and the other party’s insurance. I informed my health insurance, which then got their subrogation team involved—great news! They submitted lien amounts to the car insurance company.
When the settlement was finalized, the $15,000 that my health insurance had paid out was deducted from the settlement and paid directly to the subrogation team in full. I have a copy of the cleared check, and they confirmed receipt.
Now, however, my health insurance is sending revised EOBs to the doctors and reversing all previous payments. As a result, I’m starting to receive bills from the doctors I had already paid and for which the car insurance had covered the health insurance lien.
Is this even legal? If the health insurance company profits $15,000 by making me repay these bills that they’ve already deducted from my settlement, I’ll be left in a financial bind due to this accident.
It sounds like you’re dealing with a challenging situation. The actions of your health insurance company seem unusual, especially since they have already received payment through the settlement for the medical costs incurred. Typically, when health insurance gets involved in a subrogation claim, they should not reverse payments once they have been compensated, as this might lead to double billing for the same services.
You should definitely look into this further, as it could be a misunderstanding or an issue with how they processed the payments. Here are a few steps you could take:
Contact Your Health Insurance Company: Reach out to them directly to discuss the EOB (“Explanation of Benefits”) reversals and the bills you’re receiving. Ask for clarification on why payments are being reversed after they’ve already compensated themselves.
Document Everything: Keep a record of all correspondence, bills, EOBs, and any checked payments from the settlement. This documentation will be crucial if you need to dispute any charges.
Reach Out to Your Attorney: Since you’re already working with an attorney for the settlement, inform them of the situation. They may be able to assist in dealing with the health insurance company or provide additional legal advice.
Consider Filing a Complaint: If your health insurance company continues to pursue these steps without a valid reason, you may want to consider filing a complaint with your state’s insurance department. They may be able to help clarify your rights and obligations in this situation.
Consult a Legal Professional: If the situation escalates and you’re facing significant financial repercussions, consulting with a legal professional who specializes in health insurance or personal injury claims could provide you with tailored advice.
It’s important to resolve this quickly, as medical billing issues can lead to negative consequences if they remain unpaid. Good luck, and I hope you can find a resolution soon!