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Provider Manual

Subrogation

Last Updated on January 24, 2019

To the extent permitted by law, whenever Family Health Center provides or pays for medical services given to a member, Family Health Center reserves the right to recover the costs of medical services from another person, insurer, or organization found to be responsible for the cost of the services.

  • Examples of occurrences which may involve subrogation include:
    • dog bites by someone else’s dog
    • food poisoning
    • malpractice
    • motor vehicle accidents
    • product liability
    • slips and falls on someone else’s property

• In the event a member is injured by the act or omission of a third party, the provider may elect to bill a potentially responsible party instead of the program.  If the third party does not pay the claim in full, the provider may balance bill Family Health Center, however the program will apply all discounts and member responsibility to the outstanding balance. Members will be required to cooperate with the program to facilitate subrogation or other reimbursement from potentially responsible carriers. Should the member not cooperate with the program, claims may be denied and will be the responsibility of the member. The provider may not seek payment from Family Health Center for any claim denied due to lack of member cooperation. If the provider elects to bill Family Health Center and later receives payment from any third party, the provider will refund the total amount paid by Family Health Center for services provided.