If you have Medicare, you can use your Medicare coverage to pay medical expenses resulting from a car accident. The same eligibility applies to Medicaid. However, if you are Medicare recipient, you are required to report the car crash to Medicare regardless of whether you pursue a personal injury claim. The reason is that Medicare will seek reimbursement for any money it spends to cover your medical expenses for an injury caused by the accident.
Communicating with Medicare about your accident
If you receive Medicare, you can have your attorney handle the communications with the Medicare Coordination of Benefits (COB) contractor. These communications will include the written correspondences about your crash and all of the treatment you were given for your injury. If you are required to participate in these interactions, your car crash attorney can provide you with guidance.
Reimbursing Medicare after receiving a PI settlement
You must report your accident to Medicare. The agency will monitor your case after you report your accident. It will also inquire if you have been involved in an accident. Any failure to report or any falsehoods you make about your involvement could put in jeopardy your future eligibility to receive Medicare coverage. After your COB contractor begins monitoring your case, he or she will stay in touch with regular contacts to request more information about its progress.
Once your case has reached settlement, your attorney must inform your COB contractor of the amount of your settlement. Your attorney is not permitted to send any settlement money to you until your COB contractor has been informed.
Negotiating a settlement with Medicare
The process of negotiating a settlement with Medicare can be time-consuming and arduous. If you receive a personal injury settlement, most often Medicare will want to receive reimbursement for all of your medical bills it has paid on your behalf. This also holds true if your case went through an alternative dispute resolution process.
After the COB contractor obtains notification of your settlement from your attorney, typically the contractor will provide you with this statement outlining all of your medical bills. If the information you receive regarding those bills is correct, your attorney will attempt to negotiate with Medicare and then send you a check from your settlement amount that covers the medical expenses prior to sending you the rest of the settlement funds. You do have the option to appeal the decision of your COB. However, you will have to follow the Medicare internal appeals process which can be difficult and time consuming.
Medicare liens and appealing
Medicare places a lien on your settlement money. This means it claims a right to recover the compensation from you for what it spent to cover your medical expenses. When it comes to appealing the COB contractor’s conclusion regarding your medical bills, your settlement money may be held under this lien until the issue is resolved.
Before a decision on your appeal is issued, you will not be able to receive your full settlement, but only the amount you are owed based on the COB contractor’s statement regarding your benefits. The difference between this figure from your attorney for what you are owed and Medicare’s figure will be held in escrow. If you win the decision, you get to receive that money. If Medicare wins, it gets to keep the money.
Have you been injured in a car crash that was the fault of another party? If so, get a Gladiator on your side! The Nashville car accident attorneys at Rocky McElhaney Law Firm are here to fight for the compensation you deserve. We serve clients from our offices in Nashville, Hendersonville, and Knoxville. To set up a free case review, give us a call today at 615.425.2500 or complete our contact form.