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Section 9: Claims

9.10 Subrogation

Subrogation is a legal right held by healthcare Providers and payers to recover their expenses when their Members or employees are injured in certain types of accidents and the expenses related to the accidents should have been reimbursed by another party. 

If a Member is injured or becomes ill because of an action or omission of a Third Party who is or may be liable to the Member for the injury or illness, AHP will take steps to recover their health care costs from either the Member or the party responsible for the injury or illness.  Payment for healthcare services provided to the Member due to injury or illness caused by a Third Party shall be in accordance with the Certificate of Coverage. 

Please notify AHP when a Member has been injured in certain types of accidents and the expenses related to the accident have been reimbursed by another party by:

• Indicating the other carrier on the CMS 1500 or UB 92 claim form, or 
• Calling the AHP Service Center at 605-322-4545 or toll-free at 1-888-322-2115. 
  

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