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Are your medical services accident- or work-related?

MercyCare, like other health plans and insurance companies, researches claims that may be work- or accident-related to determine payment responsibility. This process is called “subrogation”. Subrogation entails pursuing recovery from other responsible payers, such as auto insurance, other property insurance, workers’ compensation or any other coverage that may be available.

For example, if you sought treatment for neck injuries that are commonly caused by motor vehicle accidents, then MercyCare will investigate the cause of your injury. If your injury was the result of a car accident, then your auto insurance may be responsible for paying your injury-related medical expenses.

In order to assist MercyCare in administering that portion of your health insurance policy, we have secured the services of Optum. They will research certain types of claims to determine if the injuries may be accident- or injury-related. Once claims are identified, they will go through a process of information collection for subrogation determination by sending out questionnaires for more details. Questionnaires can be answered using one of the three following options:

  • Telephone the details in and speak directly to dedicated staff during the hours of 8 am-4:30 pm CST, Monday-Friday, including TTY services.
  • Respond online via a secure web portal that is available 24 hours a day. The website link will appear on the questionnaire.
  • Mail the completed questionnaire back to Optum using the envelope enclosed with the questionnaire.

Again, subrogation is a standard process used by all health plans and insurance companies and is outlined in your Certificate of Coverage. Determining the responsible payer saves money for your employer, and ultimately for you, by keeping medical and insurance costs down.