As we have discussed elsewhere, a good car accident attorney will always advise the client to use their health insurance to pay for any medical care after a crash. It saves the client substantial money and avoids the negative inference that a doctor was a hired gun that appears in the situation where the lawyer sends the client over.
One of the biggest issues in litigation today is the problems presented where a third party medical funding company has advanced the money to allow the client to treat with a doctor. The problem is two-fold; first, the medical care is 3 times the health insurance price and that comes from the injured victim’s take-home settlement. Second, there is a danger the jury will not like the elevated price.
If you have Medicare, it can be a challenge to get them to pay for the hospital care, but they will often pay for the aftercare after a car accident. Any time you can get Medicare to pay for medical bills after a car accident, it is a blessing. Keep in mind the fact that they are a secondary payor under their own rules and they have the right to refuse to pay until the at-fault driver’s car insurance has refused to pay. We do see a number of situations where Medicare steps in and does pay.
The question becomes, what is owed out of any settlement if Medicare paid for some of the treatment. The answer is you and your lawyer need to engage in a frank discussion with Medicare about the settlement. Your lawyer cannot get cute and allocate some of the settlement money specifically to pain and suffering or lost wages to minimize or eliminate Medicare’s reimbursement rights. Here is their manual statement on the subject:
“Medicare Secondary Payer Manual
Chapter 7 Contractor MSP Recovery Rules
50 – Recoveries From Liability Insurance Including No-Fault Insurance,
Uninsured, or Under-Insured Motorist Insurance
50.4.4 – Designations in Settlements
(Rev. 1, 10-01-03)
In general, Medicare policy requires recovering payments from liability awards or settlements, whether the settlement arises from a personal injury action or a survivor action, without regard to how the settlement agreement stipulates disbursement should be made. That includes situations in which the settlements do not expressly include damages for medical expenses. Since liability payments are usually based on the injured or deceased person’s medical expenses, liability payments are considered to have been made “with respect to” medical services related to the injury even when the settlement does not expressly include an amount for medical expenses. To the extent that Medicare has paid for such services, the law obligates Medicare to seek recovery of its payments. The only situation in which Medicare recognizes allocations of liability payments to nonmedical losses is when payment is based on a court order on the merits of the case. If the court or another adjudicator of the merits specifically designate amounts that are for payment of pain and suffering or other amounts not related to medical services, Medicare will accept the Court’s designation. Medicare does not seek recovery from portions of court awards that are designated as payment for losses other than medical services.”
How Long Do I Have to Send the Bill to Medicare after a Car Accident?
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.