Medicare’s Surprising Effect On Your Settlement Or Verdict

Originally published by William K. Berenson.

A new law is closing down a deceptive billing practice that was costing seniors millions of dollars.  The NOTICE Act described in this revealing New York Times article requires hospitals to start telling seniors if they are not officially being “admitted” after 24 hours. Before this, a senior could be “observed” in the hospital and nursing home for days — even months — but not officially be admitted for Medicare purposes so they got stuck with huge medical bills.

A personal injury lawyer represents many Medicare-eligible people (someone who is 65 or older, or is younger than that if he or she is disabled or who has certain diseases) after they are injured in collisions.

How will the new law affect you?

 

Complicated Reimbursement Laws 

An out of court settlement or verdict rendered by a jury is almost always paid for by liability insurance companies, but if health insurance or Medicare is involved, you may receive far less money than you would like. Why?

Blue Cross or Medicare might pay your medical bills at the hospital or doctor, then recover the money they paid by virtue of an little known concept called subrogation. I recently blogged about it here.

How does Medicare subrogation work?

Under federal Medicare Secondary Payer statutes, the government can be secondary to the automobile liability company’s primary policy, and if it does pay for your medical treatment, demand repayment.

This process is complicated and frustrating. You must know to report the collision to Medicare or no money will be paid. Many hospitals and doctors refuse to file on Medicare and you and your attorney must prod them.

After it accepts responsibility, Medicare sends out correspondence outlining rights and responsibilities. You can set up an account online and track payments. Then a long period of coding claims and processing payments ensues.

The recipient later receives a Conditional Payment Letter several months later, but these numbers frequently change as the injured person continues treatment and providers continue to file bills.  Further delaying the process is that all medical payments, even if they are not related to the collision, are listed.

Medicare must be continually updated by the claimant’s attorney. It is almost impossible to speak to any one on the phone or email them. Medicare eventually sends out a demand letter with its final lien amount and deadline date.

Because a liability insurance company may be subject to sanctions for failing to pay Medicare its share in a settlement agreement, it can wait until it receives the final Medicare demand and proof of payment before releasing funds to you.

For example, I just settled a case last week on behalf of a 78 year old man filed against a drunk driver for a substantial sum of money, but the drunk’s liability company has held up payment pending a “no lien letter” from Medicare. We will resolve this quickly.

A personal injury lawyer can help you through this complicated process

During the past 36 years, I have found effective solutions to settle my clients’ claims expeditiously while satisfying the Medicare subrogation rules. My staff carefully reviews all medical records and bills and fights to remove unrelated charges. We push the claim forward, then negotiate with Medicare and unpaid medical providers for waivers and reductions.

If Medicare or your health insurance company has paid your medical bills after a car wreck, you need a good injury lawyer who understands the nuances of subrogation. Schedule a free consultation with Berenson Injury Law if you have any questions about your auto accident or truck accident in Fort Worth, Dallas, or North Texas.

 

Curated by Texas Bar Today. Follow us on Twitter @texasbartoday.

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