The status quo in subrogation processes is costing the clients of the industry millions of dollars per month. A truly effective subrogation strategy is incomplete without a dedicated Reimbursement Specialist assigned to the case. The most common practice in the subrogation industry is to simply send out form letters asking injured parties to provide basic information about a potential injury in order to vet out opportunity for subrogation. If this information is not provided or otherwise falls through the cracks, huge recoverable amounts can go unnoticed. At Vengroff Williams, our recovery specialists isolate specific incidents in which duplicate payments may be lurking, and leaves no stone unturned in personally reaching out to any and all third parties to recover funds.
Always-Evolving Plan Language, Part of an Advanced Subrogation Strategy
For example, January 2018, a covered member of one of our client’s self-funded ERISA benefit Plans was severely injured in a single motor vehicle accident which resulted in over $274,000 in medical bills. Being a single car incident, no third party existed. In a truly effective subrogation strategy this is not the end of the investigation. Upon contacting the member’s own auto insurance carrier, our recovery specialist learned that health providers had been paid by both the Plan and the auto insurance. The accident occurred in a no-fault state and personal injury protection (PIP) benefits were available. Because the VWi legal team had previously recommended a change in Plan language, it now contained a Coordination of Benefits provision which made the Plan secondary to No-Fault PIP benefits. It was clear to all parties that the member’s auto insurance carrier should have been the primary payor on all medical bills from the start. Multiple health providers had collected from both the Plan and the auto insurer, and thus had a legal obligation to reimbursement of our client’s Plan.
Swift Action Yields Quick Outcomes
This case was immediately referred to a Vengroff Williams attorney who guided the overpayment process using a best practices subrogation strategy. Refunds were sought from overpaid providers—almost none of which will ever issue refunds for duplicate payment voluntarily. With the patient still receiving treatment, a VWi paralegal contacted the Plan to cease future payments while putting the auto insurance carrier in the rightful designation as sole primary payor.
Had our health plan subrogation reimbursement specialist not been in place to catch this, it would have cost our client even more than the $275,000!
The Outcome of an Advanced Subrogation Strategy
Our recovery specialist going the extra mile to identify duplicate payments is just one example of what makes VWi Health Plan subrogation so advanced. Without any legal representation outside of VWi’s attorneys, without a lawsuit or any personal injury or insurance litigation, VWi was able to recover more than $275,000 for our client within three months from the date of our first demand letter. For a self-insured and self-funded Plan, this type of cash infusion goes a long way in keeping down member premiums and keeping our client’s Plan soluble with low liability.