Medicare Assistance and Personal Injury

Medicare Assistance and Personal Injury

What Happens In A Personal Injury Case When Medicare Pays For The Hospital Bills?

Receiving treatment after being injured in an accident can often be a tricky affair. Most people turn to their health insurance or other health care arrangements to foot the bills.

If you are a Medicare recipient, there is a good chance that the bills for your treatment will be at least partially covered by your medicare plan. Medicare may take care of some of the costs of your treatment and rehabilitation, and possibly other health needs you have during the period.

But there are important rules and procedures to keep in mind if you have received Medicare-funded treatment. One of the most important is that you may have to reimburse Medicare for the cost of your treatment out of whatever settlement you receive.

However, how much you have to reimburse and when you should do so may vary, depending on your case. This article explains what you should know about what happens after Medicare pays for your hospital bills.

Medicare Assistance Requirements

If you have been in an accident that requires medical treatment, and medicare makes payments for your treatment billing, you should consider whether you are required to report the accident to Medicare under federal law. You may be expected to file a report with the Medicare Coordinator of Benefits (COB) Contractor. This Contractor is typically a private company that handles reimbursements for Medicare.

You are expected to provide them with the details of your injury, the details of your health care providers and the name of your attorney. You should typically file this information shortly after your accident.

This requirement must be taken seriously and it would be wrong to proceed without caution in your case. It’s dangerous to think you can get away with receiving Medicare treatment and keeping all of your settlement. That would likely backfire.

Health insurance companies, including Medicare, typically program their systems to flag specific types of injuries. So, if they find they’re paying for setting a broken bone or other orthopedic injuries, you may get an email or other correspondence asking if you’ve suffered injury in an accident. Failure to comply may jeopardize your eligibility for Medicare in future. Worse, you may be charged with a federal offense.

When you’ve informed Medicare about the accident, you may also be required to send updates about the case to the Contractor either personally or through your attorney. They may also send you requests for updated information, which you must comply with.

What Happens After You Receive Your Settlement?

Your attorney must inform the Contractor of your settlement, within 60 days of the settlement or judgment. This report must be made before your attorney disburses any part of the settlement to you. Failure to file the report may result in a daily fine up to $1,000 per day.

The Contractor will respond to your report within 120 days by sending you a list of treatments and charges they believe Medicare should be reimbursed for. Why does Medicare take a cut of your settlement?

The law gives Medicare a medical right to reimbursement, at least partially, on your settlement amount. This means it has a right to take a sum out of your settlement as reimbursement for the treatment you received. It operates on a principle called “subrogation”.

This principle operates the same way it does with insurance companies or healthcare providers. It applies to prevent individuals from enjoying compensation for medical treatment twice. Usually, your settlement sum will include an amount for your medical bills. Since Medicare has paid those bills on your behalf, it reserves a right to be reimbursed out of the settlement.

How Much Will Medicare Take Out of Your Settlement?

This often depends. As a rule, Medicare may be entitled to collect the full value of the amount it sends in your statement. Federal law instructs whether or not the Contractor may accept a negotiated amount in most cases. So you may or may not be able to negotiate for a lower payment.

There are exceptions to the “no reduction” rule. If you are represented by an attorney, Medicare may reduce its fee to account for the attorney fee and case bills. This is because it recognizes that your settlement would already be reduced by attorney fees, which may be a substantial portion of your recovery if it’s a contingency arrangement.

Also, if you recover less than $5,000 for your claim, Medicare will accept a fixed percentage of the amount as full and final settlement of the treatment costs, even if they’re much higher. In this case, you only have to pay 25% of your settlement to discharge the entire lien.

Do You Have to Accept Whatever Amount Medicare Sends?

No you don’t. Keep in mind that Medicare is only entitled to reimbursement for the medical care you received as a result of the injuries you suffered in the accident. For instance, if you suffered a broken leg in the accident and then undergo treatment on the leg from January to May, you have to reimburse them for those treatments. But if you had a flu shot in March and then in May, the medical lien will not apply to those costs.

You and your attorney should review the list of treatments and charges for accuracy and take out any unrelated medical treatments from the list. If you agree with the list, your may send the Contractor a check for the amount in the statement and that’s all.

But if you believe there are unrelated costs or medical bills in the statement, your lawyer should notify the contractor. Medicare will review the statement and send a final payment demand within 30 days, either removing the disputed items or insisting that they are related to your personal injury treatments.

At that point you may want to either to accept the bill or appeal through the Medicare administrative appeals process.

Contact our Kansas City Personal Injury Attorneys for Help

The process of settling Medicare claims after recovering your settlement can be quite complicated, as you’ve already seen. Where the process is handled poorly, it may prevent you from quickly accessing your hard-fought settlement.

When you work with experienced Kansas City personal injury attorneys, you stand a greater chance of a smoother process. If you would like to learn more about how we can help you for a smooth recovery process, contact us online or call our attorney at (816) 631-2868 today.