Do I Have to Pay My Health Insurance Provider Back for Medical Bills?

 Posted on August 17, 2015 in Personal Injury

By Mark Imielski and John Martoccio

Everyone knows that if you get hurt in an accident and it is someone else's fault you can sue them in order to compensate you for your injuries. However, if you reach a settlement or go to trial and are awarded money damages by a jury, you will not be the only one receiving a check.

The doctors that treated you, the hospital where you struggled through physical therapy, and even your own health insurance provider are entitled to a portion of your settlement under the Health Care Services Lien Act (770 ILCS 23). This comes as a shock to many people, especially for those whose medical bills exceed the amount of their settlement.

Luckily, a new provision was added to the Act in order to protect you. Before 2013, your health insurance provider had the ability to recover the full amount money it paid out to cover your medical expenses. Under the new subrogation provision of the Health Care Services Lien Act (770 ILCS 23/50), your health insurance provider's ability to seek repayment from you for your medical expenses can be reduced.

For example, if you incur $100,000 in medical bills and the person who injured you is only insured for $50,000, your insurance provider's right to seek repayment from you will be reduced proportionately. Meaning, if your insurance provider paid $20,000 of your medical bills and you settle your personal injury case for $50,000, the maximum amount your provider can recover under the new law is $10,000.

It is important to note that this new law may not apply to claims that arise under federal law. If you receive health insurance through plans that are subject to the Employee Retirement Income Security Act (ERISA), or the Federal Employees Health Benefits Program (FEHB), your ability to utilize the law will be limited because ERISA and FEHB contains provisions which allow them to take the place of state law.

Do not let your health insurance provider take more money than they are entitled. If you have been in an accident, or are negotiating a settlement on your own, contact the attorneys of Martoccio & Martoccio today.