Who is Carelon Subrogation? Why are you asking me to complete this questionnaire?
Carelon Subrogation LLC is a company that specializes in third party liability and workers' compensation recoveries. It is part of Carelon, the healthcare services business of Elevance Health. Carelon Subrogation has been retained by your health plan to investigate and recover money for any medical claims that were paid due to accidental injuries where another party may be responsible for payment, such as an auto insurance policy or workers' compensation carrier.
Why does Carelon Subrogation have my claim information?
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) allows Carelon Subrogation to receive your protected health information and send questionnaires as part of the claims payment process for your health plan.
Do I have to respond to the questionnaire even if my treatment is not related to any accident?
Yes. Your response will help Carelon Subrogation determine if another party may be liable for medical expenses paid by your health plan. Responding to the questionnaire is required by the terms of your health plan. If you have any further questions about this, please refer to your plan documents or summary of benefits.
What should I do if I cannot remember what happened on the date of service you provided?
If you cannot recall or have questions about the service that was provided on the date shown on the questionnaire, please contact our Customer Care Center at 1-800-645-9785, and one of our customer care associates will be happy to assist you. You will be asked for your reference number shown on the questionnaire, along with your date of birth and the date of service. Please keep in mind that if the health plan member is over the age of 18, they should contact us directly.
Why are you asking me about a date of service that happened over a year ago?
Sometimes when Carelon Subrogation starts working for a health plan, the plan may not have used a subrogation company in the past. The health plan may, therefore, have requested that we go back a reasonable amount of time to check prior claims, sometimes up to a year. It might also take several months for claims to be received and paid by your health plan. Other factors that might contribute to the age of the date of service would be a change in your address, or if your claim was previously denied and then adjusted for payment.
I answered a questionnaire already, why am I receiving another one?
If you recently returned a questionnaire, it may be that your response and the questionnaire crossed in the mail. Carelon Subrogation automatically sends additional questionnaires at certain intervals if no response is received. If you responded some time ago, but continued treatment, it is possible that a new questionnaire was produced due to those additional treatments.
If you receive a questionnaire and believe that you have already responded to it, please call our Customer Care Center at 1-800-645-9785 to verify with a representative whether we have received your response.
Who is the provider shown on my questionnaire? I never saw this doctor or went to this clinic/hospital.
Often when you have a radiological service such as an MRI or an X-ray, the results may be interpreted by a doctor other than your treating physician. This is very common, and in most cases, you will not be familiar with that doctor's name.
There are also times when your provider is part of a larger group or billing company, and you may not recognize the name. If you have any questions regarding the provider, you may contact your health plan using the number listed on your identification card.
Have my medical bills been paid?
Carelon Subrogation only sends questionnaires on claims that have been paid by your health plan. In general, the claim for the date of service on the questionnaire has been paid according to the terms of your benefit plan. Carelon Subrogation cannot verify benefits or guarantee payment of any claims. If you are concerned with the status of a claim or payment issue, you should contact your health plan by using the phone number for customer inquiries found on the back of your identification card.