Car Accidents
In some personal injury cases, one of the most important things our lawyers do for our clients is getting significant reductions in a Blue Cross/CareFirst lien.
Do I Have to Pay CareFirst Back for a Lien?
More Settlement Information
If your medical insurance provider is Blue Cross CareFirst, it will typically send you a subrogation letter if they notice treatment that could potentially involve a tort claim.
Why does CareFirst do this? People get angry when they learn that CareFirst wants repayment for the medical bills they have paid. Our clients often are understandably upset, wondering why they bought health insurance in the first place when they get a subrogation letter from Blue Cross. Our lawyers agree.
But Maryland law – and the law in most states – is clear that if your injuries were the result of someone else’s negligence and you are compensated for those injuries, health insurance carriers are allowed to require repayment if there is a settlement or verdict in your case that gives money to you for the accident. So we have to deal with these liens and try to do the best we can to pay back as little as possible. In some personal injury cases, the best thing we do for the clients is to negotiate their liens.
Contract with Care First Usually Begins with a Subrogation Letter
A lot of our clients have Care First/Blue Cross/Blue Shield liens. In my office, we talk about “Blue Cross Blue Shield liens,” but it is a misnomer. Technically, the healthcare provider does not have a lien. What they have is a contractual agreement with you that if you are injured by a third party and that party makes payment for your medical bills, you will pay them back.
Do you “have to” pay them back? Well, that depends on your definition of “have to.” First, in some states, your lawyer cannot disburse your settlement funds if they have been put on notice of a claim by CareFirst or another healthcare provider. So that is the first hurdle in trying to blow one past CareFirst Blue Cross.
What Can Happen If You Do Not Payback Care First
Let’s assume for a second that either your lawyer is willing to ignore the lien or CareFirst has never put the lawyer or the client on notice. If you don’t pay back the lien, a lot of bad things can happen.
Lose Health Insurance
First and foremost, you can lose your health insurance. No explanation is necessary as to why this is a bad thing. But if you have been badly hurt, you are more susceptible to future injury. So the risk is the same as everyone else, only squared.
Retract Old Payments
The health insurer will do more than just cut off future coverage. It will likely retract all of its payments to healthcare providers. When this happens, the client loses the “health insurance paid for it” discount, which means it may be obligated to pay the full amount in some, probably most, cases. Moreover, you can expect Care First to file a lawsuit to get their money.
Getting Reductions
At least in Maryland, CareFirst is relatively easy to deal with on these lien issues (Eugene Seidel’s office in Baltimore handles most non-federal Care First subrogation claims). But they demand to be treated fairly and you should expect consequences if you are not. If you lie or mislead any lienholder, you will never again get the benefit of the doubt.
Federal CareFirst liens are handled out-of-state and they are more difficult to deal with in reducing liens. Cases sometimes go to trial because you just cannot talk sense to the adjuster. But if there are unique aspects to your case, there is a meaningful chance they will make an accommodation for you. But you have to work hard and separate yourself from hundreds of other lawyers that are looking for a reduction that do not lay the appropriate foundation for a meaningful reduction.
Keep in mind that these are general rules that may vary from state to state. You will want to speak to an accident lawyer who knows the law in your jurisdiction. We are writing about Maryland personal injury cases. Most of the rules we are talking about cross over to other states…but not all.
Tips on Getting the Best Possible Reduction in Your Lien
1. Gather All Necessary Documentation
This is an obvious place to start, right? Start by collecting all relevant documents related to your medical treatment and expenses. This includes medical bills, records of treatment, and any correspondence with Blue Cross/CareFirst. Having comprehensive documentation will support your case when negotiating the lien amount.
2. Understand the Lien Amount
Request a detailed breakdown of the lien request from Blue Cross/CareFirst. This should include the specific amounts paid for each medical service. Review this breakdown carefully to identify any discrepancies or charges that should not be included. Remember, if the bill is not related to the treatment for the personal injury claim, it should not be included. Sometimes, it is not clear-cut. If it is arguably not related, make that argument.
You do want to verify that the subrogation claim is lawful. After that, patients and their attorneys can potentially reduce the amount owed to insurers from personal injury settlements, thereby maximizing the compensation they retain.
3. Negotiate with the Lienholder
Contact Blue Cross/CareFirst to discuss the possibility of reducing the lien. Provide them with the details of your case, including the total settlement amount and any other claims against it. Emphasize any hardships or financial burdens you face and present yourself or your client as a real human being. That makes a difference. Insurance companies usually consider these factors and will agree to a reduced amount.
Monitoring and Follow-Up
4. Regularly Follow Up
Stay in regular contact with Blue Cross/CareFirst throughout the negotiation process. Squeaky wheels really do get the best oil if it is done with professionalism and respect. Follow up on any offers or counteroffers promptly and ensure that all agreements are documented in writing.
5. Final Settlement Agreement
Once a reduced lien amount is agreed upon, ensure that you receive a final settlement agreement in writing from Blue Cross/CareFirst. This document should clearly state the reduced amount and confirm that it satisfies the lien.
Getting Help from a Lawyer
Our personal injury lawyers guide our clients through this process with health insurance liens. We have done it hundreds of times and have saved our clients millions of dollars by getting reductions in their liens. Our attorneys do it in the right way. So it does not come back to bite our clients.
If you have been injured in an accident or by medical malpractice, call one of our lawyers at 800-553-8082. Our personal injury lawyers handle accident lawsuits throughout the United States. You can also get a free, no-obligation online consultation.