Understanding the ins and outs of Medicare can require you put on your detective cap. If you are 65 or older or you have an older parent who was injured in an accident, you may need help navigating the process. In addition to seeking out an experienced personal injury attorney, it doesn’t hurt to educate yourself.
If Mom is a Medicare recipient and she is injured, Medicare may cover the cost of her medical care. But if the costs Medicare pays are the result of an injury and there is a successful personal injury case outcome with settlement funds, she will be required to repay Medicare for any previous payments.
In order to protect its right to reimbursement, Medicare has an automatic lien on any compensation received for the personal injury claim. Unlike cases that involve private health insurance, Medicare offers little to no flexibility to negotiate the lien amount.
MEDICARE PROCEDURES AND RULES THAT YOU SHOULD KNOW
- If you get into an accident and require medical treatment, federal law requires that you report the accident to the Medicare Coordination of Benefits (COB) contractor. If you don’t have the contact information in your paperwork, you can find it at one of Medicare’s websites, cms.gov or medicare.gov.
- Once you’ve settled your case, your attorney must notify the COB. Your lawyer must do this before distributing the settlement proceeds.
- Medicare requires reimbursement for all medical bills that it paid on your behalf. Medicare has a very strict calculation on how the amount to be repaid is calculated.
- After reviewing and agreeing on the conditional amount paid, your attorney will send a check for the reimbursement amount after applying Medicare’s calculation formula. If you believe the statement is inaccurate, you and your attorney will begin the Medicare internal appeals process.
The penalties for not paying back the Medicare lien are significant. There are penalties for both the Medicare beneficiary as well as the attorney for failure to properly address a Medicare lien. That is why one of the first questions most personal injury attorneys will ask is whether or not you received any medical treatment through Medicare.
“One of the benefits of hiring an attorney is that the client can concentrate on getting well. Aspects of a personal injury claim are time-consuming and complicated,” Brad Parker says. “We can deal with insurance companies, bill collectors and outstanding liens, which reduces stress on the client.”
If you are hurt in a car accident and need the help of an experienced personal injury lawyer, call Parker Law Firm for a free strategy session at 817.440.3888.