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Phone: (314) 241-2500
Alvin Wolff Jr. & Associates

Q
My health plan paid my medical bills from my car wreck and now wants to get paid back. Do I have to pay it back?

A

Your plan is a state sponsored plan and is exempt from ERISA.   ERISA has some onerous terms that require repayment in many circumstances.  Because your health plan is a state government sponsored plan, it falls outside of the ERISA requirements for reimbursement.   Missouri is an antisubrogation state so state law controls your requirement for repayment; not federal law.   Therefore since Missouri does not allow subrogation and because your plan is not ERISA controlled, the plan's claim for reimbursement is not a valid claim.

These determinations are made from an exhaustive review of the applicable laws and plan language.   Just because you get a bill from your health plan administrator, that does not mean you owe it.

Sometimes you get to give the plan a "nice try" award instead of money.