I am sorry to say that other side of the coin was omitted in your March 14 cover story, "A Real Class Act." First, the ultimate responsible party is the "tortfeasor" or third party insurance which you stated but left out the details.
I am sorry to say that other side of the coin was omitted in your March 14 cover story, "A Real Class Act." First, the ultimate responsible party is the "tortfeasor" or third party insurance which you stated but left out the details.The details are this: If Jane Doe is carried by Acadian, then there are two possibilities of reimbursement to which Acadian can pursue with only one being "fully" responsible, the third party insurance. In other words, no matter who Acadian bills, and no matter who pays the bill first, the ultimate pay comes from the third party insurance. This brings me to my second point, which is how the health insurance is reimbursed. The health insurance is "subrogating" the third party insurance for reimbursement. So having said that, technically, the health insurance is fully reimbursed by subrogation. Why should Acadian have to give the discount when the health insurance is receiving all of its money back and is not responsible? Acadian does not have a contract with the third party insurance that is fully responsible. Another way to look at it is this: Acadian is choosing to not involve the health insurance knowing it will subrogate. So the health insurance company is saving money by not having to pay the claim (which costs money), then send out notices of subrogation (which costs), track the claims (which costs) and then reprocess the same payment that was made in the first place, which also costs. All of these steps cost money and involve the health insurance that is ultimately not responsible and is reimbursed anyway. So why can't Acadian choose who to seek reimbursement from if all the money comes from one place? Finally, this is the first question the health insurance asks once a claim comes across their desk: "Is there a third party responsible or is this a work related injury/accident?" The question is asked for a reason.
Dr. Robert LeJeune