Subrogation Information for Hospitals and Providers
Claims should be immediately filed with Blue Cross and Blue Shield of Alabama when treating a patient that has been involved in an accident of any nature. In accordance with our PMD, Participating Hospital, Preferred Home Health, or Preferred DME agreements, it is our policy to consider each claim under normal contract benefits and make payment accordingly to the provider.
When Blue Cross is involved in subrogation activity, the full amount of the Blue Cross payment should be refunded to Blue Cross not to exceed the amount received. Any remaining amount over the Blue Cross allowable should be refunded to the patient or returned to the issuing carrier.
Payment made under the terms of the provider’s contract agreement is to be considered as payment in full. Liens should not be filed against a patient with valid Blue Cross coverage, except to cover any deductibles, copayments or other out-of-pocket expenses related to treatment. Any such liens should be filed only after reasonable efforts have been made to collect amounts deemed patient responsibility.
Alabama House Bill 11, which became effective August 1, 2019, clarifies the hospital lien provisions and places a requirement upon hospitals to seek payment for claims from a patient's health insurance provider first. The hospitals can no longer hold back the bills to extract a higher payment from a third party.
Alabama Code 35-11-371
Alabama Code 35-11-371 will now include the following critical language:
(b) Unless specifically contrary to any contractual agreement between the hospital and the injured person's health care payor or unless contrary to any statute or governmental rule or regulation of the United States or this state, no hospital shall perfect a lien as to any injured person who was covered by a health care payer's policy, until the hospital submits to the health care payor an accurate and properly coded claim, or if a contract exists between the hospital and the health care payor, in the form required pursuant to the contract, and there is a failure to satisfy the claim.
For more information about subrogation for hospitals and providers, email Subrogation-Referral@bcbsal.org.