In the event treatment is provided to a HealthChoice member for injuries sustained in an accident, and there is a third party at fault, the Plan has subrogation rights. All Network Providers should be aware that their contract requires claims to be filed with HealthChoice. In addition, provider contracts strictly prohibit Network Providers from collecting any amounts from HealthChoice members that are in excess of the Allowed Charges and/or that exceed the member’s deductible and coinsurance liability. The only exception applies to services not covered by the Plan or if annual or lifetime benefit limits have been reached.
More information regarding Subrogation can be found in Title 74 of Oklahoma Statutes, Section 1306.1. Subrogation information is also available in EGID’s Official Rules.