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Subrogation
Health Advantage makes our members' health-care financing needs a priority.
When our members are injured, we ensure their medical bills are paid according to their policy, even
if the injury fault lies with another person or party.
What Is Subrogation?
In health insurance, subrogation refers to the legal right of an insurance company — after payment of a loss —
to recover monies from the responsible party's insurance carrier. For Health Advantage, it refers to those times
when another insurance carrier may be responsible for payment of medical care. For instance,
when an injury occurs because of an accident in which someone other than the plan member is at fault,
the insurance carrier of that individual may be responsible for the payment of the plan member's medical treatment.
In those cases, Health Advantage may be entitled to recover the value of the services from the other carrier.
However, we will pay for the medical treatment of our members immediately, so that our members are not burdened by
waiting for the responsible party to pay.
Health Advantage uses Healthcare Recoveries (HRI), a division of Trover Solutions, Inc., to help in recovering
subrogation claims. HRI is an independent company that operates separately from Health Advantage and is solely
responsible for assisting in the recovery of subrogation claims. If you or a covered family member are injured
in an accident, you will receive a letter from HRI that asks for you to call their Customer Service department
to provide details regarding how the injury occurred. If the injury was caused by someone else, on another party's property or in an automobile accident,
HRI will contact the responsible party and request reimbursement to Health Advantage for the cost of the medical
care provided because of the injury.
A successful subrogation program helps Health Advantage keep the cost of health care reasonable for you and your employer. We appreciate your cooperation with HRI.
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