Until the 1980s, it was rare for a health insurer to rely on subrogation and reimbursement as a significant cost savings application. However, identification of potential recovery cases has been dramatically improved through the use of systems detection methods such as the programs developed by The Rawlings Company LLC. These automated systems, combined with increased personal injury claims and economic factors, make subrogation and reimbursement necessary parts of any cost savings program. What was once a relatively dormant area of law has developed into a dynamic process in which the health plan must work to maintain its right to recover benefits when there is another source (such as a third party or other carrier) that has a primary obligation for paying those benefits.
This law manual can be used by the Law Department and Subrogation Divisions of Health Benefit Indemnity Companies, HMO’s, and PPO’s, as well as third-party administrators (TPAs) and law school libraries. Further, this handbook can be used as a convenient reference for issues that now frequently arise with subrogation and reimbursement claims and will enhance the management, administration, and recovery of such claims.
The 2018 edition of this manual updates changes to the law in all 50 states and the District of Columbia. Commentary and relevant case law pertaining to the Federal Employees Health Benefits Act and Medicare are found in the “Introduction” section of this manual. Information pertaining to ERISA follows. Here the reader will find selected case law pertaining to the preemption of state laws regarding subrogation, any made whole rule and the common fund doctrine. The final section of the manual examines state laws relevant to subrogation and reimbursement on a state-by-state basis. As the leading compilation of its kind, this manual is the perfect handbook to assist in the management, administration, and recovery of health plan subrogation and reimbursement claims.
The 22nd Edition is available for purchase on Amazon.com through the following link: https://www.amazon.com/dp/0991391586