Summer 2004
Subrogation & Your Health Plan
Have you ever looked at a word and tried to guess it's meanings but the
definition doesn't come to you? What is subrogation besides just another
technical word? Webster’s Dictionary defines it as:
| |
sub·ro·ga·tion (sùb´ro-gâ¹shen) noun - a
third
party (acting) as a creditor or insurance company
substituting for another’s legal right to collect a
debt or damages. |
Subrogation is a provision of your Health Plan that
comes into effect when you are entitled to other benefits or settlements
from another party related to a medical claim that Blue Cross has already
paid.
An example of subrogation would be if you were injured in an auto accident
and your Health Plan pays the hospital bill instead of the other driver’s
car insurance. The Health Plan has the “legal right to collect a debt or
damage” for the hospital bill from the other driver’s car insurance company.
This also includes recovering money from a lump sum settlement from an auto
accident.
Blue Cross will seek to recover its medical payments on these types of
claims and help you by insuring the responsible party pays for the cost of
your medical care. All you have to do is notify Blue Cross when you have an
accident, and they will do the rest.
The Joint Health Care Committee acknowledges subrogation as defined by
Article III, Section 10 (e) of your current Health Plan. The Plan does not
assume primary responsibilities for medical expenses, which another party is
obligated to pay. As a convenience to the beneficiary, the Plan may pay for
such expenses initially. However, the primary and ultimate responsibility
for payment shall remain with the other party or carrier. Obligations to pay
benefits on behalf of any beneficiary are conditioned upon the beneficiary
taking all steps necessary to help recover the costs from any third party
that may by obligated to pay.
The Health Plan further states that Blue Cross can require the beneficiary
to complete such documents that are “reasonably required.” You may have
received a subrogation questionnaire in the mail from Blue Cross. Many JWR
employees are not returning the questionnaires to Blue Cross as requested.
These questionnaires are necessary to obtain information from you regarding
the cause of your injuries.
This newsletter is to make you aware if you are mailed a subrogation
questionnaire from Blue Cross, the purpose will be to obtain necessary
information from you. Under the subrogation provision of your Health Plan
you are required to comply with the subrogation process. If you receive a
questionnaire in the future, please respond in a timely manner as requested.
Failure to complete a questionnaire could suspend or terminate your future
health coverage with Blue Cross and/or require you to be responsible for
subrogation medical expenses. |
