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Provider Manual

Subrogation

Last Updated on August 28, 2018

To the extent permitted by law, whenever Security Health Plan provides or pays for medical services given to a member, Security Health Plan 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 Plan.  If the third party does not pay the claim in full, the provider may balance bill Security Health Plan, however the Plan will apply all discounts and member responsibility to the outstanding balance. Members will be required to cooperate with the Plan to facilitate subrogation or other reimbursement from potentially responsible carriers. Should the member not cooperate with the Plan, claims may be denied and will be the responsibility of the member. The provider may not seek payment from Security Health Plan for any claim denied due to lack of member cooperation. If the provider elects to bill Security Health Plan and later receives payment from any third party, the provider will refund the total amount paid by Security Health Plan for services provided.