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Health Insurance Coverage

Denver Health Insurance Bad Faith Lawyers

Health Insurance

How Does Health Insurance Get Involved?

There are many Denver personal injury situations in which you would seek assistance from your health insurance company. For example, if you or a loved one has been injured in a car accident, health insurance provides the primary source of payment for accident related medical expenses. There may be an exception to this rule if there is “medical payments” coverage on one of the automobile insurance policies providing coverage for the accident. This is usually known as “med-pay” coverage. If there is med-pay coverage, it is primary and is the first to cover things like ambulance bills and emergency room bills. Once this coverage is exhausted (many times there is only $5,000.00 in med pay coverage), health insurance is implemented and typically covers the remaining amount owed for accident related medical care.

With respect to health insurance coverage, most, if not all, health insurance plans provide that the plan must be paid back a portion of the medical bills paid if money is recovered from a third party. This is known as insurance “subrogation.” Importantly, the health insurance plan only seeks repayment for the reduced amount of the bills it pays while the at-fault party is generally responsible for the full amount of the
medical bill.

To illustrate how this system works, consider the following example: Assume someone is hurt in an accident and incurs a $10,000.00 emergency room fee. Because of contracts between the health provider and the health insurance company, the health insurance company only pays $3,000.00 for the bill. Because of Colorado’s Collateral Source rule, the at-fault party generally is responsible for the full $10,000.00 bill while the injured party only needs to pay back $3,000.00. Colorado law generally provides that between the innocent victim and the person who caused the accident, the victim should get any extra remainder based on his or her prudence in obtaining health insurance.

Further complicating this issue, the remaining portion of the $3,000.00 paid by the health insurance company must be paid back depends on several factors. This issue must be addressed in every case and is extremely important because it directly effects how much money the injured party ultimately receives.

If you or a loved one has been injured in an accident, contact us today. The lawyers at Fuicelli & Lee, P.C. are experts in insurance subrogation and insurance related issues.