Lien Paid – Now Reversing EOBs
Last year, I was involved in a car accident and was advised to utilize my health insurance to manage medical expenses while my claim was being processed by my attorney and the other party’s insurance. I informed my health insurance company, and they promptly involved their subrogation team, which was great! They sent the lien amounts to the car insurance company.
When it came time for the settlement, the $15k my health insurance paid out was deducted from my settlement and sent directly to the subrogation team without any issues. I have a copy of the cashed check, and they confirmed receipt.
However, now my health insurance is sending revised Explanation of Benefits (EOBs) to the doctors, reversing all prior payments. As a result, I’m starting to receive bills from doctors I’ve already settled with, and the car insurance had previously covered the health insurance lien for those amounts.
Is this even legal? If I have to repay all these bills that the health insurance has already accounted for from the settlement, they would essentially profit $15k, leaving me at a loss from this accident.
It sounds like you’re dealing with a complex situation involving subrogation, health insurance, and the repercussions of your car accident. While I’m not a lawyer, I can provide some general information that may help you understand your situation better.
Subrogation Process: What you’ve described seems to involve the subrogation process properly in theory. When your health insurance paid for your medical expenses, they had the right to seek reimbursement from the party responsible for the accident (in this case, the car insurance of the other party).
Reversing Payments: The health insurance reimbursements you’re seeing could be related to their internal accounting or a change in their policy regarding how they handle payment streams after a settlement. However, reversing payments and trying to claim for amounts they’ve already settled seems like a problematic practice and may not be legal.
Legal Advice: It would be a good idea to consult with a legal professional who specializes in insurance or personal injury claims. They can clarify your rights and obligations and help you navigate this situation effectively.
Documentation: Keep all documentation related to this process, including the settlement check, any correspondence from your health insurance, and the bills from your doctors. This will be crucial for any legal or advocacy steps you choose to take.
Communication: Contact your health insurance’s subrogation team directly to clarify why they are sending reversed EOBs and what that means for your bills and obligations.
Consumer Protection: If you feel you’re being treated unfairly, you may also want to reach out to a consumer protection agency or your state’s insurance department to report the issue and get additional guidance.
Your situation sounds stressful, and it’s crucial to get informed legal advice to protect yourself and ensure that your rights are upheld.