If you are a Medicare recipient and you are involved in a personal injury
claim, Medicare will cover any medical expenses related to the injury
claim. However, there are certain procedures and rules you need to know.
Report the Accident Claim to Medicare
If you are involved in an accident and need medical attention for injuries
caused by the accident, federal law requires you to report the accident
to the Medicare Coordination of Benefits (COB) Contractor, which is a
private company that processes reimbursement of Medicare benefits for
recipients in personal injury cases. The Medicare COB Contractor will
collect information about your case, such as the details of your injury,
the names of your healthcare providers, and the name of your attorney.
If, however, you fail to report the accident to the Medicare COB Contractor,
chances are they will find out one way or another. Health insurance companies
program their computers to flag payments for medical treatment derived
After You Report the Accident to Medicare
Once you report the accident, Medicare will start to monitor your case.
The COB Contractor will routinely send you and your attorney requests
for updated information. It is imperative to comply with these requests
to ensure your eligibility for Medicare.
After Your Case is Settled
Once your case is over, your lawyer needs to inform the COB Contractor
that the case was settled. This must be done before you receive any of
the settlement proceeds. The COB Contractor will then send your attorney
a statement which details all of the medical bills that Medicare paid
that the Contractor believes are related to your personal injury case.
According to federal law, the amounts on these statements cannot be negotiated,
so there is little to no chance of reducing the lien.
Then, you and your attorney must review the COB Contractor’s statement.
If everything seems fine with the statement, your lawyer will simply send
the Contractor a check for the statement amount when he or she disburses
But if you believe that the statement contains medical expenses not associated
with your personal injury case, your attorney must inform the Contractor
of those disputes. The response from the Contractor could take a month
or two. If the Contractor agrees with your attorney, a revised statement
will be sent.
By contracts, if the Contractor disagrees with your position, then you
and your attorney will need to decide whether or not to appeal the Contractor’s
statement or concede and pay the Contractor. If you choose to appeal,
your lawyer will start the Medicare internal appeals process. Your lawyer
cannot disburse to you the full amount of the settlement while the appeal
is pending. Depending on the circumstances, your attorney will either
send the disputed amount of the Medicare lien to the COB Contractor or
hold it in escrow.
Due to the complexities of Medicare issues, you should speak with a qualified
lawyer. For more information,
contact our Austin personal injury attorney at
The Stewart Law Firm, PLLC today.