Why is this “nosy” company asking about my accident?

If you get a letter from a company called Healthcare Recoveries, Inc. (HRI) asking about a medical claim you have made for benefits under the Empire Plan, it’s O.K. to answer it.

Answering won’t delay or reduce the payment of your claim, and it might save the Empire Plan money and help reduce premiums for all Empire Plan enrollees.

Here’s how it works.

If you or one of your covered dependents is injured, another person or their insurance company may be legally responsible for your resulting medical expenses, not the Empire Plan. Common examples are a motor-vehicle accident or a medical-malpractice judgement that includes payment of an injured party’s medical expenses.

The Empire Plan is “subrogated” to your legal claims. That means the Empire Plan carriers go ahead and pay your claims, but they also “stand in your shoes” and can make claims against the third party.

The law requires the Empire Plan carriers to seek repayment for claims they have paid for treatment of your injuries, but that are more properly the responsibility of another carrier, such as an automobile insurer.

The Empire Plan hospital and medical carriers (Empire Blue Cross Blue Shield and United HealthCare) contract with HRI to administer the Empire Plan’s subrogation provision, including certain recovery efforts.

So, if the Empire Plan has paid claims on your behalf that might be the liability of a third party, HRI may send you a letter asking for information about those claims.

“If you receive a letter from HRI, please answer its questions even if you think no one else is responsible for your claim” said PEF health benefits specialist Lorraine Simpkins.  It won’t cost you anything, and it helps hold Empire Plan premiums down for everyone.”