Florida Blue asking about slip-and-fall accident I had in July

[Amethyst]

Bottom line: I tripped and fell in front of a business, went to the ER, and now my insurance company is asking questions about responsibility. I am improving, and don't want to start a legal battle.

Background: Back in July, my foot hit a rubber mat on a concrete sidewalk directly in front of a business, causing me to trip and fall and re-sprain a healing hamstring (ow!!).

Employees helped me inside and gave me first aid for a scraped knee. I walked away (limping slightly). Later, I went to the ER due to pain. Xrays found no fracture. I was instructed to see an orthopedic surgeon, who determined that I'd re-injured my left hamstring. I am in physical therapy, which is helping.
The ER billed BCBS almost $2,000; my co-pay was $250.00.

I just got a questionnaire from Florida Blue seeking to find out if another party is responsible for my costs. It asks if I was injured at work, at home, or on someone else's property, and asks me to describe what happened. I responded to "name address of other party," but should I have mentioned the business?

It would be a lie to say I tripped at home, but I have no desire to get involved in any legal wrangling over responsibility.

 

[FlaMariner]

Similar situation and I've learned the questionnaire is routine....

Her Majesty broker her hip falling at home on the stairs. The insurance company (not FLA BCBS) asked us via online questionnaire and snail mailed questionnaire the same sort of questions......In fact, they had to have that before they would complete the claim.

My advice is to just answer the questions and send in the form. If they want to get involved further, they will, but it is doubtful unless you are pursuing it and if so, they want their piece of the action $$$.

All the best in healing.....It's been a slow slog for Her Majesty but she is fine!

 

[FLSUnFIRE]

Let the insurance companies figure out the liability.... it's what they do! I wouldn't sweat it and you didn't "rat them out." Now if you called good old Morgan and Morgan crying for $MMM then I might think differently.


Hope it heals well and you fully recover!

 

[RetiredAndLovingIt]

I got a similar letter from a company representing Kaiser a couple of years ago which I threw in the trash. They kept contacting me and finally I called Kaiser and told them to back off. It was a minor injury and the party that caused it was my dog who jumped on me as I was stepping into the shower and knocked me over and I ended up twisting my ankle IIRC. I think they use a special code in urgent care that triggers these letters.

 

[street]

Let the insurance companies figure out the liability.... it's what they do! I wouldn't sweat it and you didn't "rat them out." Now if you called good old Morgan and Morgan crying for $MMM then I might think differently.


Hope it heals well and you fully recover!

^ this. I also wish you a full recovery.

 

[pacergal]

I would bet it is routine for insurance companies to follow up any injury type visit.
I think how you answered was fine. The insurance company will follow up and work it out.

glad you are continuing to improve

 

[Dash man]

I get those a couple of times per year since 2006 when I was diagnosed with Cervical Disc Degeneration Disease. It’s routine and I would just answer it truthfully and let them deal with it.

 

[Sunset]

I went in for back surgery, and while chatting causally mentioned to the anesthesia doc, before being drugged, I think I probably hurt my back bare foot water skiing when I fell.

A month or so after the surgery I get a letter asking for details on the cause of my injury...

I figure the doc told someone, and gets a kickback for reporting it.

I ignored the letters and they stopped.
What I hadn't mentioned was it happened decades ago.

I found it interesting they do this as a way to reclaim some money that was paid out.

 

[Amethyst]

I'm so glad she has recovered!

Similar situation and I've learned the questionnaire is routine....

Her Majesty broker her hip falling at home on the stairs. The insurance company (not FLA BCBS) asked us via online questionnaire and snail mailed questionnaire the same sort of questions......In fact, they had to have that before they would complete the claim.

My advice is to just answer the questions and send in the form. If they want to get involved further, they will, but it is doubtful unless you are pursuing it and if so, they want their piece of the action $$$.

All the best in healing.....It's been a slow slog for Her Majesty but she is fine!

 

[MichaelB]

Bottom line: I tripped and fell in front of a business, went to the ER, and now my insurance company is asking questions about responsibility. I am improving, and don't want to start a legal battle.

Background: Back in July, my foot hit a rubber mat on a concrete sidewalk directly in front of a business, causing me to trip and fall and re-sprain a healing hamstring (ow!!).

Employees helped me inside and gave me first aid for a scraped knee. I walked away (limping slightly). Later, I went to the ER due to pain. Xrays found no fracture. I was instructed to see an orthopedic surgeon, who determined that I'd re-injured my left hamstring. I am in physical therapy, which is helping.
The ER billed BCBS almost $2,000; my co-pay was $250.00.

I just got a questionnaire from Florida Blue seeking to find out if another party is responsible for my costs. It asks if I was injured at work, at home, or on someone else's property, and asks me to describe what happened. I responded to "name address of other party," but should I have mentioned the business?

It would be a lie to say I tripped at home, but I have no desire to get involved in any legal wrangling over responsibility.

Best wishes for a full and pain free recovery.

I don’t think you’re at risk of ending up in the middle of a legal squabble. The amount BCBS is on the hook for isn’t enough to involve lawyers. My guess is they’d just write a letter asking for reimbursement and let it go.

 

[MarieIG]

Bottom line: I tripped and fell in front of a business, went to the ER, and now my insurance company is asking questions about responsibility. I am improving, and don't want to start a legal battle.

Background: Back in July, my foot hit a rubber mat on a concrete sidewalk directly in front of a business, causing me to trip and fall and re-sprain a healing hamstring (ow!!).

Employees helped me inside and gave me first aid for a scraped knee. I walked away (limping slightly). Later, I went to the ER due to pain. Xrays found no fracture. I was instructed to see an orthopedic surgeon, who determined that I'd re-injured my left hamstring. I am in physical therapy, which is helping.
The ER billed BCBS almost $2,000; my co-pay was $250.00.

I just got a questionnaire from Florida Blue seeking to find out if another party is responsible for my costs. It asks if I was injured at work, at home, or on someone else's property, and asks me to describe what happened. I responded to "name address of other party," but should I have mentioned the business?

It would be a lie to say I tripped at home, but I have no desire to get involved in any legal wrangling over responsibility.

This happens all the time. I am not familiar with Florida law but in NY if it was a work related (covered under workers' comp.) or auto injury (covered under no fault), your medical insurance (most likely) would not pay at all until the bills were reviewed by those insurance providers as there is a statutory order of responsibility for bill payment arising out of certain types of injuries. Regarding a trip and fall accident, they are looking to see if they can recoup money from a responsible party or perhaps, place a lien on a lawsuit.

My son had multiple herniated discs - and the insurance company probably wrote to us twice a year looking for a lawsuit. (There was none.)

I wouldn't worry overly much about it. (The store may have a "med-pay" policy which covers the bill. Otherwise, the store's liability carrier would likely refuse - depending upon Florida law.)

 

[Amethyst]

My fear would be that BCBS would refuse to pay, and say it is the business's responsibility. At that point, I would be very upset and not know what to do!

I think people are saying not to worry.

 

[pb4uski]

BCBS will pay, but if they believe that the business is responsible then they will chase them and their insurer for reimbursement. It's called subrogation.

What is subrogation in simple words?

"Subrogation," or "subro" for short, refers to the right your insurance company holds under your policy — after they've paid a covered claim — to request reimbursement from the at-fault party. This reimbursement often comes from the at-fault party's insurance company.

 

[Kings over Queens]

This ^.

Insurance company isn't looking to get you involved in any lawsuit, they are looking to recover the money they paid for you care, or claim. I'd recommend giving them the info, any penny they can recover helps keep premiums down.

 

[SecondCor521]

I figure the doc told someone, and gets a kickback for reporting it.

Highly, highly unlikely.

Generally, kickbacks in the medical field are illegal. One can't, for example, refer you to their medical imaging practice without disclosing the relationship and giving you notice that you can take the referral anywhere you want to.

Generally, a medical professional disclosing private health information without your permission or a legal requirement is violating HIPAA, which is a BIG no no.

The only legal reason I can think of offhand would be if the medical professional thought you were being abused, or might harm yourself, or might harm others. Or, of course, to submit a claim to your insurance company, but that is limited to what they did (surgery, office visit, lab test, etc) and the dollar amount charged. It doesn't generally include your lab results, surgery outcome, or any real detail.

 

[jollystomper]

I just got a questionnaire from Florida Blue seeking to find out if another party is responsible for my costs. It asks if I was injured at work, at home, or on someone else's property, and asks me to describe what happened. I responded to "name address of other party," but should I have mentioned the business?

This is routine. Whenever anyone in our family encountered a physical injury, the insurance company contacted us to get details like this. We were honest and provided the information, and that was it. Our insurance company covered us, and whatever they worked out with the other parties insurer we never heard about it.

For that amount, as was mentioned, there probably will be no legal action, just back-and-forth between your insurer and the business insurer.

 

[athena53]

It’s called subrogation. Nothing evil about it, just a process to get payment from an at-fault party rather than have the general health insurance system bear it. Same thing happens if it’s a work injury or the result of an auto accident.