Medicare and Car Accident Claims
When it comes to car accidents and clients in Georgia with Medicare coverage, the analysis of who does what and when can be tricky.
A hospital cannot bill Medicare if prompt (within 120 days) payment is expected from a liability insurer( car insurance for the at fault driver).
Any billing to Medicare must happen with 12 months of the patient discharge from the hospital. If the patient has Medicare and the hospital does not bill Medicare within that 12 month window, then it can never come after the patient to pay the bill but it can still assert a Georgia Medical Lien against any potential injury settlement from the car accident.
The hospital cannot have it both ways and submit to Medicare and make a lien claim. The submission to Medicare invalidates the lien claim. See Medicare Secondary Payer Manual, Chapter 2 Sec 40.2 Provision E
If you don't have Medicare and are just fighting with the hospital on the amount of the lien, your sole attack is on the reasonableness of the cost of the medial care. OCGA 44-14-470 and 471. In a recent Georgia Supreme Court case, the Court allowed the Plaintiff to get discovery of how much the hospital got paid but certain health insurers and under other rate plans so that a jury could decide what is fair in the industry. Unfortunately for the actual victim, the Plaintiff's lawyer in this case should have taken the hospital's offer to settle for $8500 on a $21,000 bill. It's hard to beat that discount at trial. Bowden v. The Medical Center, Inc.