Last year I was involved in an accident. I went to my HMO and they didn’t help much: one visit with the PCP, one with physical therapy, and a CT scan. Since it took forever to get PT appointments with them, I found my own care out of network. The other party’s insurance accepted liability and we settled for a total $4k for medical visits, and $2.5k for pain and suffering. I spent about $2.3k in physical and sports therapy.
Well over half a year after the incident, I get a voice mail from someone that wants to talk about “my accident on [date]”. They do not say anything specific and I consider the matter settled, so I ignore the call. A few weeks later I get a letter from the “Rawlings legal company,” claiming that they work with my HMO, my HMO has priority on any settlement I got and they want me to sign a HIPAA release form.
Because (a) no one at my HMO ever said anything to me about this company or that they’d be contacting me about the cost of care, (b) I believe they are misrepresenting themselves as attorneys, and (c) they are asking me a HIPAA release (wouldn’t they have all the information from my HMO if they were working for them?), I decide to ignore the letter.
A couple months went by, and I got a voice mail again. This time they are citing the policy claim.
My question: should I respond? What happens if I don’t? My HMO failed to provide adequate care and it didn’t provide any bills for service other than copays. Then, months after I’m fixed and the matter has been settled based on the care I received out of network, they send some bill collectors and claim “guess what, we get first dibs on anything you got”. I’m very confused and I don’t understand how this is even legal.
Confused about subrogation letter from the Rawlings company
byu/amadorUSA inInsurance
Posted by amadorUSA
4 Comments
[deleted]
The settlement paperwork probably said any liens/etc are your responsibility?
If you didn’t bill the car insurance on the initial visits and your health insurance paid, they’re obligated to be reimbursed.
Even still, if they picked up the tab because the insurance wasn’t paying, they’re obligated to be reimbursed.
Unfortunately because you’ve already settled, you’re responsible to reimburse the health insurance for what they’ve paid.
Rawlings is just doing their due diligence. They always send letters and usually call. They will bug you until you answer. They just want to know if there is any company that Rawlings can go after, or subrogate, for medical bills. You can just tell them honestly that you already settled and that you paid your bills and (I’m assuming) you signed a release so your claim is closed for further handling. Since your injury claim already settled theres no need to sign any HIPAA forms.
Edited to add: I usually find their adjusters to be pretty overworked so they are typically glad to take your call and then close out your file