United Brachial Plexus Network, Inc.

I don't know if this has happened to anyone else, but last week I received a letter in the mail from a collection agency requesting funds paid out on the behalf of Rain since she received a settlement. Of course, I immediately called my attorney's office to find out if the money they were asking for was due to them. They stated that as a result of the accident with Rain they were not willing to pay for all of her medically related expenses. When we originally signed up with this insurance group I made them totally aware of Rain's injury. I asked their rep numerous times if this injury was going to affect her coverage since they considered it a pre-exsisting condition, and I was assured that due to the fact they were an HMO they could not deny coverage to anyone so we would be in good condition. We actually didn't sign up with them until Rain was almost a year old. What they are asking for are some of the therapy visit cost refunded, visits to her pediatrician (who by the way does not treat her bpi) and some of the surgical costs incurred with the ModQuad surgery. The total they are wanting is 22,500.50, but they are willing to settle for half. Like what, I should now thank them? Not a chance. I was talking with rep in the legal department at the collection agency, and she said that Rain was not entitled to coverage for anything pertaining to this ACCIDENT as she said it unless the insurance group approved it. DUH!! I let her know that all of the medical attention that Rain has gotten so far has been properly authorized before we sought treatment. They are now turning around and changing their minds. They said that the facts surrounding this injury were misrepresented to them, they had no clinical information before them regarding how the injury was sustained (etc, etc) It's not brain surgery people. Here's an idea, Why not request birth records, and any other medical records needed and you will see the problem. They have the incident date recorded as May 7,2001 (which was the date Rain had Mod Quad) as the date the problem began. Rain was born in Feb 2000, but the rep said she has no proof of that. It was like pulling teeth. Finally, I got tired of attempting to talk to this IDIOT of a woman and told her to call my attorney, I gave her the number again, and told her to never ever for as long as she had breath in her body, to call my house again. She was more than rude, like the money was deducted from her paycheck or something. Anyway, my attorney is out of town for trial at present, but his co-attorney is working to get the matter straight. It has just been one big headache as if I don't have enough to do. Oh well, I'll see how this one works out. I'll keep you posted. Thanks for listening.

DeShawn, hey girl!! It's been a long time...
Anyway, we were told during the three years of legal proceedings that we would be responsible for paying our insurance company back if we won at trial. At that time I was so mad at the thought of it!! That is the law for reimbursement. Not that we have to worry about it now but I would love to be able to pay them back! Did your attorney NEVER once mention this to you?? I don't know actually if it varies from state to state and insurance company to insurance company or not. But my attorney said this is generally the rule, but we didn't go into specifics.
Good luck and hug Rain for us!!
Natalie and Logan

Hi Nat,
Thanks for replying. It has been a while since we talked. I haven't posted on the board in a while but, I was interested in seeing what everyone's thoughts on this were, but I guess there are really no other thoughts huh. I hope to talk to you soon. Big hugs to you and Logan.

DeShawn

DeShawn,

We received letters from our previous insurance company and our current company asking if our daughter's injury was caused by a third party and whether we have retained a lawyer. My understanding is most insurance companies "piggyback" on the child's lawsuit and the lawyer would offer to handle the insurance company's claim if they agree to a lower amount. What I always wondered is what happens if the child needs future surgeries. Will the insurance company pay for it or not. Does it depend on whether the child received money from the lawsuit? Makes me wonder what health insurance is for then.

Hi DeShawn,

How the heck are you? Do you remember me? It has been forever since we have talked. I hope you and Rain are doing well.

I am sooo sorry you are having to go through all of this. Always seems to be something that sneaks up on us. I know the issues of reimbursing early intervention programs and insurance are being looked into by our attorney now, months before trial. It seems that your attorney should have discussed this possibility since it may directly impact the amount you are willing to settle for. I sure hope they are wrong and I hope they no longer have rights to collect from you. I know there are varying time limitations in each state. Get your lawyer on top of it and hopefully everything will get straightened out soon.

Take Care,
Elisa

Did they ask for subrogation documents before they paid for treatment? On Katie's once they started getting the first few bills someone noticed hey there is an injury code on here and some !@#%^&* high bills, what is going on? They contacted me and it was in our policy that they expect to be remibursed. However, several attorneys have told us they usually settle for "some on the dollar" instead of the full amount.

Christy, the way it works is that the insurance company has the right to sue the doctor just like you do. So instead of hiring their own attorney, they use yours and become part of your case. They will sometimes discount up to one third because they are discounting based on what the attorneys fees would have been which is usually one third. But the attorney has to negotiate that discount. Some states don't allow this and some states do. This is someting each person has to ask their attorney about. Also, the state will also put a lien on the case for you to payback Early Intervention services, etc.

Insurance companies take it from you every which way they can. AND don't forget that you are still paying their monthly premiums for your health insurance. So you pay for the care and then you have to pay it back anyway.

Nothing about this injury is fair.

We had to pay back our insurance company a%of what was paid for surgeries etc from our sons settlement. I was actually ok with that because I was thankful they had been there when we needed them and covered the surgeries in the first place. It's no different than if someone were to be injured in a car accident. Strike that. The difference is that then the car insurance comany lawyers hash it all out rather than in our situation where the parents must seek representation in order to be compensated. But as someone mentioned here before. The hmos could have sought restitution themselves from the drs. but that will obviously never happen so if a parent sues they go along for the ride. If an award or settlement is made they get reimbursed. Thats better than them making families who get nothing from a lawsuit have to come up with $20-30,000 to get surgery for their child. I'm just really suprised your lawyer didnt mention this to you before. There is I believe a statute of limitations though on how long the insurance company has to come back and demand money of you after a settlement is made. I thought it was one year but maybe that varies by state.

This is normal and if you think about it , if it's the doctors fault then the insurance or settlement he gives you is responsible. We had to do this with Michaela's and yes our insurance company settled for only 30 percent of the total they had paid out. THE GOOD NEWS IS they can never deny claims stating it is another parties responsibility, after that has been taken care of. I specifically asked my attorney and he says they have to treat it like any other pre-existing condition and at least in the state of Florida,all insurances have to pay for pre-existing conditions so there really is no such thing.
It all comes down to what pot of insurance is responsible. Like if you get hurt at a friends home their homeowners is responsible instead of your health insurance. If you get in a car accident then the car insurance is responsible, not your health insurance. I hope I explained this sufficiently.

Lee Anne! WOW! your atttorney got it down to only 30% - how did they do that? Our attorney has gotten them to discount 30% so we have to pay them 70%. I wonder what your attorney did? We're not written in stone yet - can you email me? francine@injurednewborn.com