Dive Brief:
- The U.S. Supreme Court heard oral arguments this week in a case examining whether health insurers or beneficiaries are entitled to money patients are awarded in court due to an injury.
- Montanile v. Board of Trustees of the National Elevator Industry Health Benefit Plan focuses on the issue of what happens when a health plan beneficiary wins injury money in court, but then spends it.
- The question being asked is whether the beneficiary still has to reimburse the health plan for the medical expenses it covered.
Dive Insight:
The decision could potentially set a precendent that would impact the more-than-$1 billion per year that plans collect from such reimbursements.
The insurer in the case argues it's entitled to the money through its coverage agreement with the beneficiary, and if beneficiaries are allowed to pass on making those payments, their actions will impact the affordability of health plans.
The opposing argument for Robert Montanile states insurers can not demand reimbusement when the injury award has already been spent, per the federal Employee Retirement Income Security Act (ERISA). Montanile, who was struck by a drunk driver, is said to have spent the $500,000 he received in court on medical expenses, lawyer fees, and living expenses.
An attorney for Montanile called the argument “overblown,” Modern Healthcare reports.