What is the process of subrogation in health insurance?

Subrogation is an important concept in health insurance that allows an insurer to recover costs associated with a claim when another party is responsible for the insured's injuries. When an insurer pays for medical expenses or other damages incurred by a policyholder due to an accident or injury caused by a third party, the insurer has the right to pursue reimbursement from that third party. This process essentially shifts the financial responsibility back onto the party who is at fault.

For example, if a person is injured in a car accident caused by another driver, their health insurance might cover medical expenses initially. However, the insurer can then seek subrogation against the at-fault driver's liability coverage to recover the costs they incurred for that claim. Through this process, the insurer aims to minimize their losses and ensure that the costs of medical care are ultimately borne by the responsible party rather than the insurance company and the insured individual.

In contrast, the other choices pertain to different aspects of insurance operations that do not relate to the recovery of costs through third parties. There are processes for determining coverage limits, calculating premiums, and setting time limits for filing claims, but none of these involve the insurer’s right to seek reimbursement as subrogation does.