Can we bill Attorney for Medical cost ?


Subrogation is another liability recovery activity in which medical costs that are the result of actions or omissions of a third party are recovered from the third party (and/or his insurer). In some instances, Tufts Health Plan has the right to recover the value of services provided to Members for which a third party is responsible.

Tufts Health Plan has outsourced subrogation recovery services to the Rawlings Company in La Grange, KY, and as a result you may receive correspondence from Rawlings related to duplicate claim payments (e.g., Tufts Health Plan and a motor vehicle carrier). Inquiries related to such claims should be directed to the Rawlings Company representative at the number indicated on the correspondence. All other subrogation questions should be directed to the Provider Relations Department at 1-800-279-9022.

Note: Do not bill the member or the member’s attorney directly even if you are requested to do so by either of them. If you choose to bill the member or attorney directly, you do so at your own risk.

Motor Vehicle Accidents (No-Fault or PIP Coverage)

Tufts Health Plan coordinates with no-fault auto insurance coverage Personal Injury Protection (PIP) and/or Medical Payment (Medpay) on claims for services rendered as a result of a motor vehicle accident (MVA). Members should not be billed or required to pay up front for services as a result of a MVA, other than applicable cost-sharing amounts. For motor vehicle accident claims, providers should bill the motor vehicle carrier directly. The no-fault auto insurance coverage is primary for the full PIP coverage and/or any available MedPay coverage.

After receiving the insurer’s statement or check, if further payment is requested for a Tufts Medicare Preferred HMO member, providers must bill Tufts Health Plan within the 60-day filing deadline date from the date the statement or check was issued.

Note: Under your Tufts Medicare Preferred HMO contract, once the member’s PIP and MedPay benefits are exhausted, you cannot balance bill the member or file a lien against the member’s third party settlement or judgment. For more information, refer to the Motor Vehicle Accident Payment Policy on our website. For questions regarding third-party liability, contact the Rawlings Company at 502.587.1279.

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