Idaho Health Insurer Reimbursement: What the Law Says and What We Could Not Confirm

By the FigureMyTax Editorial Team · How we calculate

We did not find an Idaho statute that adopts the made-whole doctrine or limits a health insurer's reimbursement. Idaho Medicaid is expressly paid first whether or not you are made whole.

What the made-whole doctrine is

The made-whole doctrine says an insurer that paid your bills cannot be repaid from your recovery until you have been fully compensated. Some states enact it by statute, and others leave it to courts or to the insurer's contract. We searched the Idaho provisions we read on liens, collateral sources and Medicaid and found none for a health insurer.

What a secondary source reports

A law-firm compilation of Idaho subrogation law reports that Idaho allows subrogation of medical and disability benefits, that no reported state court case adopts the made-whole doctrine for automobile insurance subrogation, and that a federal appeals court applies it to ERISA plans as a default rule unless the plan disclaims it. We did not read the cases, so treat this as a lead and ask an attorney.

Collateral sources

Idaho Code 6-1606 says a judgment may be entered only for damages that exceed amounts you received from collateral sources. But collateral sources do not include benefits paid under federal programs that must by law seek subrogation, life insurance death benefits, benefits of certain service corporations, or benefits recoverable under subrogation rights created by Idaho law or by contract. So payments by a plan with a contractual subrogation right are not deducted from your judgment, which leaves the plan's claim for you to resolve.

A worked example

Say your health plan paid $9,000 and you settle for $100,000 with a one-third fee and $3,000 in costs. With no statute to limit it, the plan could claim the full $9,000 under its terms, and the Idaho medical lien calculator shows it as an upper bound. Ask the plan, in writing, for a reduction for your fees and costs and for the fact that you may not be fully compensated.

What to do

Ask for an itemized claim and the plan document. A self-funded employer plan may be governed by federal law, which can displace state rules. See how hospital liens differ from an insurer's claim and how Medicaid and Medicare recover.

This is general information, not legal advice, and the state comparisons above are illustrative, not an exhaustive survey. Confirm how Idaho's rules apply to your specific case with a licensed Idaho attorney.