Originally Posted by
Factor
I had a sports-related injury a few months back, and I recently received a letter from a company named Vengroff, Williams & Assoc. asking me to self-report if the injury was due to a third party, and if so provide details. It goes on to state in extended legalese that I agree to reimburse the FedEx/Anthem plan any benefits or damages I receive from a third party. It also threatens that if they don't receive the requested info, my "medical bills related to any claim may not be considered for payment."
None of this applies in my case since there wasn't a third party involved in my injury, but am I even obligated to fill out & return this form? I haven't heard anything back from ALPA R&I folks on the matter, but I generally don't like the idea of agreeing to legally-binding Subrogation Agreements I just randomly receive in the mail...
Pretty common practice, and I would be surprised if it's not already in the fine print of "The Plan" that few of us have ever read. I would be surprised if the ALPA benefits specialists say anything different.
Lots of ways to hurt a shoulder, and lots of different outcomes. If you overexert yourself during a game of racquetball and need to visit the doctor, your health insurance provider pays. End of story.
If you are involved in an automobile accident and hurt your shoulder, you still visit the doctor, your health insurance provider still pays, but there's more to the story. Whose fault was the automobile accident? If it was your fault, end of story. If it was the other driver's fault, your health insurance provider will seek to recoup their costs from the other driver and/or their automobile liability insurance provider. If the accident was due to a manufacturing defect, they may try to recoup their costs from the manufacturer. If the accident was due to a road hazard that could be blamed on someone else (a municipality, a third-party not involved in the actual crash), they may try to recoup their costs from anyone else they can blame. Your (our) health insurance provider is in business to make money, not to pay out claims.
If you are walking through the produce section at Kroger and slip and fall and injure your shoulder, again you will visit the doctor and your health insurance provider will pay, and again there's more to the story. They'll go to Kroger to receive reimbursement for the costs they incurred in covering your health care. If Kroger gave you money directly in order to make you happy and avoid bad press about slip and falls in their store, your health insurance provider will want that money to offset their costs, and according to the fine print in our plan, it rightfully belongs to them. They don't want you making money on the side for slipping and falling. Some morons might be motivated to slip and fall for sport and profit.
The alternative to this process is for the health care insurance provider to delay payment of any benefits until a full investigation of any incident is concluded and any responsible parties have paid the insurance company. You overexert yourself, or you're in a car accident, or you slip and fall at Kroger, and you go to the doctor. YOU pay for the care received, you file with the insurance company, and then you wait. You wait for them to investigate and determine fault, you wait for the court system if they have to get involved, you wait for them to receive payment, and THEN you get reimbursed weeks, months, or maybe years later.
Me, personally, I just want them to pay the bill when I go to the doctor.
In your case, all you need to tell the health insurance provider is disclose there was no 3rd party involved. In my opinion, that's not a big deal. Furthermore, I'm betting it's required by our plan.
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