MY HEALTH CARE PLAN IS CLAIMING THAT I NEED TO PAY THEM BACK OUT OF ANY RECOVERY–IS THIS TRUE?

ANSWER: While the question is simple, as in many unsettled areas of the law, the answer is not. Health care plans routinely claim a right to reimbursement from patients who have a personal injury claim against the parties responsible for their injuries. However, many times these claims are unfounded and in some instances even fraudulent. Whether or not a health care plan has a right to reimbursement, sometimes called a subrogation claim or a statutory lien, depends on a number of factors. The first factor is whether the health insurance policy or plan document contains any right of reimbursement. Second, some states’ laws (such as Missouri) prohibit reimbursement of medical expenses in personal injury claims. Third, federal law may preempt state law for bills paid by certain federal programs such as Medicare, Medicaid, etc. Fourth, some federal laws such as ERISA are unsettled so that the right to reimbursement has not been finally determined by the courts. Fifth, even if there is a right to reimbursement, the health care plan should reduce its claims by your pro rata share of attorney fees and costs so you do not have to pay for their recovery. Finally, even then the repayment amount may be negotiable depending upon the facts of your case and the strength of the reimbursement claim. In sum, this is an area in which you must seek legal advice from an experienced attorney. The law is difficult and may still be in a state of change which makes reimbursements subject to negotiation that might save you a lot of money.