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Injury FAQ

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

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, they will pay for your injuries when you file a claim. However, there are certain rules that apply to this that you should know. In some cases, there may be a "Medicare lien." A lien is the right to keep possession of property belonging to another person until a debt owed by that person is paid.

A "Medicare lien" can happen if the total amount of your injuries is in dispute. That means other insurers may disagree with the amount and not pay it on time. When this happens, your doctors and other providers may bill Medicare to recover the costs of your care.

This is known as a Medicare Secondary Payer recovery claim (MSP), or a "Medicare lien." Medicare will pay on a conditional basis if the "item or service is reimbursable under Medicare rules," which means they expect to recover the amount of money they paid for your medical services if there is a judgment or award in your favor.

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.

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 lawyer, they will ask for their name and information, too.

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.

Once you have reported your accident to Medicare, they will 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.

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.

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