|Frequently Asked Questions|
1) What is your relationship with my health insurance company?
Your health insurance company has contracted our office to assist in health insurance subrogation matters. Our company investigates certain situations where your health insurance company has paid for medical services that may be the responsibility of a third party. If someone else was responsible for injuries sustained by you or your dependents, they should bear the costs of your medical care.
2) Why did I get a questionnaire from your office?
You received this questionnaire because we received information that you or your dependents were seen for services that may be accident related. Such services are often caused by a traumatic injury, and have specific diagnostic codes that indicate such injury.
3) Why do you need this information?
Under the law, a person who causes injuries to another should bear the full cost of the consequences of their actions. They should have to pay for your medical expenses even though you had the foresight to invest in insurance. A second reason is that by receiving reimbursement for costs that your health insurance company should not have to bear, it keeps costs lower than they otherwise would be!
|4) What does this letter mean?|
The letter asks if in the past three years you or your dependents were involved in any one of the following situations:
a) motor vehicle accident
b) worker's compensation incident
c) a slip and fall
d) medical malpractice
e) products liability
f) any other situation where a where a third party
was responsible for your injuries
In the event a third party was the one who caused you or your dependent's injuries, it should be the responsibility of that person or his or her insurance company to pay for your medical treatment.
5) What sort of treatment triggers these letters?
The types of treatments that trigger these letters are services of a physical nature, including but not limited to such services as MRIs, chiropractic treatment, physical therapy etc. Also any services related to muscle sprains or strains, broken bones, etc.
6) Can you tell me what diagnostic code I was seen for?
Our office can provide you with the date of service, but due to recently enacted privacy laws, we are not authorized to release treatment information. However, you may contact your plan's Customer Service Department for instructions on how to obtain specific diagnosis codes. The number for Customer Service may be found on your membership ID card.
7) Why do you need this information?
If you or your dependent were involved in any of these accidents, and a third party is responsible, then our company seeks reimbursement on behalf of your health insurance plan from the responsible party or any applicable uninsured/ underinsured motorist coverage. This helps keep health care costs as low as possible for you!
8) The treatment I was seen for had absolutely nothing to do with any sort of accident. Why am I still getting a letter?
Although your treatment may have qualified for a letter, the treatment you or your dependents received may not have been related to any of the situations mentioned in our letter. If that is the case, then please let us know so that we can close our file, and we thank you for your cooperation.
9) Why isn't the date of treatment on the letter?
The letter is asking if you or your dependents were involved in any situation in the past three years- it is not necessarily related to one particular date of service. Additionally, the date of service that we receive is only the most recent- it does not include prior services that may also be related.
10) I don't know if I was involved in any of these situations.
If you don't know if any of these situations apply to you, then they probably do not. Please do not hesitate to contact our office if you need assistance.
11) Why do you need to know about other policy members if the letter was not addressed to them?
The questionnaire letters are addressed to the Policyholder, regardless of who may have received the services. This questionnaire seeks information on all policy members.
12) What information do you have about me and where did you get it?
Your health insurance company provides information to our office in accordance with applicable laws and regulations for protecting your personal health information. We receive only the information necessary in order for our office to meet our obligation to your health insurance company. This includes your name and address so that we can send this letter to you. This information also includes diagnostic codes so that we can identify those claims that are likely to be related to the situations we investigate.
13) What do you do with my information?
Your information is used by us only to determine if you should be sent a questionnaire, and to get a response to that questionnaire. We do not share your information with any person or company other than your health insurance company and our associated law firm, the Law Offices of Eugene A. Seidel, P.A.
14) Why don't you already have this information? The hospital already asked me these questions and/or my health insurance company paid the bills so they should know.
Although your health insurance company paid your medical bills, they do not know the cause of your injuries. Sending questionnaires based on claims information is consistent with industry standards, and is a more efficient method for obtaining the information needed to determine those situations that may be the liability of another party.
15) Are you ambulance chasers?
We represent the subrogation interests of your health insurance company. We do not, and cannot, represent you in any sort of accident-related lawsuit. We are simply trying to determine whether someone else should have paid your medical bills, and if so, we try to get reimbursement for your health insurance company.
16) What will happen if I don't answer this questionnaire?
Under your health insurance contract with your health insurance company, you are required to:
a) notify it as soon as possible that a third party may be
responsible for your injuries
b) furnish information and assistance in the investigation
of such claims
c) reimburse the company if you receive monies from a
responsible third party
Therefore, if you do not answer these questions, you may be in violation of your contract with your health insurance company.
17) Do I owe you money? Do I have to pay you back for my treatment?
We are not trying to collect a debt from you! We are simply trying to collect information. However, if you recover money from a responsible third party or a relevant insurer, by way of settlement or judgment, then you have an obligation under your health insurance contract to reimburse your health insurance company for the medical expenses it has paid as a result of that accident. If you are compensated for such medical expenses, that money would rightfully belong to your health insurance company as the party that actually paid the medical expenses.
18) How will this affect my future medical coverage?
Your future medical coverage will be governed by the terms of your health insurance contract. It is not affected by our investigation.
19) I receive these same treatments often and have gotten many letters. Is there any way to stop this?
Although we understand this may be an inconvenience, we have an obligation to your health insurance company to investigate all claims that qualify. To reduce the number of letters you receive, please respond within the time allowed to avoid second requests. If you are treating for the same condition over a long period of time, it is possible to get additional letters. However, once we receive a response, we allow six months to pass before another letter is sent.
20) I am a Virginia resident. Since Virginia has an anti-subrogation statute, why do I need to answer this questionnaire?
Although the Commonwealth of Virginia does have a statute that disallows subrogation recovery, it does not apply in every case. For example, your contract may exclude benefits for services related to a work injury, which is one of the situations identified by this questionnaire. It is still important that you answer the questionnaire so that our office can determine whether the statute applies, and whether your insurance company can be reimbursed in your particular case.
21)Can I contact you to discuss this further?
Please feel free to contact our office with any other questions you may have. One of our legal assistants is referenced on your letter, however if they are unavailable any member of our staff should be able to assist you.