I’m a medicare subscriber and I was injured in a car accident. How does that affect my settlement?

If you have been injured and are on Medicare, the Centers for Medicare and Medicaid Services (CMS) will usually pay for your injuries when you file a claim.

However, there are certain rules that apply to this that you should know.

Contacting Medicare After You Were Injured in an Accident

If you’ve had an accident and were injured, you must contact Medicare to report the claim. This is required by federal law. You need to get in touch with the Medicare Coordination of Benefits (COB) contractor as soon as possible to report the accident.

The COB contractor will ask you what happened and the names of your doctors. If you have hired a personal injury attorney in connection with your Texas auto accident, the COB contractor will ask for the name and information of your lawyer as well.

If you do not report the accident, Medicare will likely still find out about it. They can see what has been charged for your care and what it was for. Failing to report it could result in you losing your Medicare benefits.

Medicare Liens and Auto Accident Settlements in Texas

After you seek medical attention, your insurers other than Medicare may disagree with the amount of your medical bills. Then they may not pay the bills on time.

When this happens, your doctors and other providers may bill Medicare to recover the unpaid costs of your care. This is known as a Medicare Secondary Payer recovery claim (MSP), or a Medicare lien.

  • A lien is a legal term describing a creditor’s right. If someone owes you a debt, a lien permits you to keep others’ property in your possession until they pay their debt to you.

With a Medicare lien, if you recover money in the settlement, that amount paid by Medicare will be deducted and returned to Medicare.

If you do not recover money in your liability claim, the Medicare payment will apply. You will be responsible for your co-payment and deductibles in keeping with your standard Medicare procedure.

Medicare Will Make A Conditional Payment To Your Healthcare Provider

If you are awaiting a settlement, Medicare will pay your healthcare provider if the “item or service is reimbursable under Medicare rules.”

Once you have reported your accident to Medicare, they will assign a Coordination of Benefits Contractor to monitor your case. This means they will continue to follow the care you receive and add any new information. They will also check to see if there have been any changes to your claim.

Medicare Monitoring Period When A Liability Settlement Is Pending

During this monitoring period, Medicare may request certain information from you and your lawyer. This can include any updates from you that they may not have received. If Medicare asks you or your lawyer for any type of information, you are required by law to provide it.

It is important to carefully review everything you receive from Medicare to make sure you understand it. You should keep all of the information regarding your accident together just in case you have any questions about your claim or need help with certain documents.

The Centers for Medicare & Medicaid Services (CMS) can receive the money they paid for your claim from many sources. These include primary insurance providers, doctors, private insurance companies, lawyers and state agencies that have received payment. It is a good idea to hire a lawyer if you have a “Medicare lien” claim.

Liability For Latent Injuries and Medicare Reimbursement

Sometimes a medical injury only shows up years after the incident that caused it. For example, asbestos can cause cancer and asbestosis decades after exposure.

If you were exposed to asbestos exposure before December 5, 1980, you may be entitled to a financial settlement for your injuries. In many of these cases, there will be no Medicare lien, by law.

Warriors For The Injured

If you have Medicare and have been injured by someone else’s behavior or carelessness, speak to a Texas personal injury attorney to understand your rights.

Justinian & Associates has represented hundreds of injured victims on Medicare. We know the system, and will fight to make sure you receive all the compensation you are entitled to under the law.

Call, text or email us for a free consultation with a seasoned Texas personal injury attorney. Tell us your story, and we will explain your options under Texas state law and Medicare regulations. There is no obligation.

And unless we get you money for your injuries, you owe us nothing. Your rights can be lost if you wait. Call us for a free consultation.