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Has Your Health Insurance Company Ever Reimbursed Your Premiums?

The title of this blog post is a rhetorical question, because the answer is assuredly “no”.  It would be nice if health insurance companies reimbursed your premiums if you did not see the doctor.  While it would be nice, it is not going to happen.  The reason it will not happen is because you pay for insurance to provide you a safety net if something bad happens to you.  You want to know you are covered if you get hurt or sick.  Also, the entire scheme of health insurance is built on the model that other people’s premiums pay for your health costs.  This model works and seems fair.  The customer does not ask for premiums to be refunded, and the health insurance company pays doctors’ bills when they arise.

You expect the reverse to also be true.  If you use your health insurance benefits to pay for a doctor, then your health insurance company should not ask to be paid back out of your pocket.  You might be thinking there is no way a health insurance company would ask you for money in addition to your premiums, but in reality, health insurance companies ask for “reimbursement” all the time.  A reimbursement situation arises when a person is injured by the negligence of another, typically a car wreck.  When the injured person receives money from the person or company that was negligent, the injured person’s health insurance company demands that it gets paid back for the medical expenses it paid for.  Many health insurance companies will go so far as to sue their own customers to get money back.  The health insurance companies will even demand to be reimbursed in situations when the injured person is not made whole by a personal injury settlement.

Take for example a car wreck where someone suffers several broken bones that require surgery.  The physical recovery from an injury like this can lead to missed time from work, and an extended and painful rehabilitation.  Assume now that the medical bills for the hospital and surgery are greater than $25,000.00.  Now assume that the person who caused the wreck does not have assets and only has minimum liability insurance of $25,000.00.  It would not be fair for the health insurance company to get the $25,000.00 from the negligent driver.  While it would not be fair, that is what many health insurance companies demand and even sue over.

I point out this out to make people aware that this happens, and to make sure people are informed that health insurance companies are not always entitled to “reimbursement.”  State law differs from Federal law on this issue and much depends on where you receive your health insurance benefits.  So please, if you ever have a question about health insurance reimbursement, please contact us. We handle these issues all the time and can help to guide you to a just and fair result.

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Posted in: Automobile Wrecks