What is subrogation in health insurance?

• A. The insurer pays out-of-pocket only.
• B. The patient is responsible for third-party damages.
• C. The insurer seeks reimbursement from a third party responsible for the injury or illness after paying a claim.
• D. The provider files the claim with alternate insurer.

Answer: (C)

Subrogation means the insurer, after paying your medical claim, can collect those costs back from the person or party legally responsible for the injury or illness. This keeps you from being paid twice for the same loss and helps keep insurance costs down. For example, if a car crash injures you and your health plan covers the medical bills, the insurer can pursue the at-fault driver or that driver’s liability insurer to recover those payments. The insured still retains the right to pursue compensation from the liable party if needed, but the insurer handles the recovery of medical expenses. This isn’t about you paying third-party damages or the provider filing with another insurer; it’s about the insurer reclaiming medical costs from the party at fault after they’ve been paid.