If you are a Medicare beneficiary or even have a replacement or advantage plan through providers like Blue Cross, Humana, United Healthcare, or People’s Health, you need to be extra careful when it comes to knowing your reporting requirements following a car wreck, especially when the accident resulted in medical treatment.
Medicare Wants To Know About Your Accident:
Federal Regulations require you to take Medicare’s interests into consideration following an accident, illness, or injury which may be the responsibility of a third party. This includes car accidents caused by another driver.
The accident is usually reported to Medicare through the Benefits Coordination & Recovery Center (BCRC) and/or the Centers for Medicare & Medicaid Services (CMS) and includes information about the accident, the responsible party’s insurance, and your injuries. Medicare then reviews any payments they may have made to medical providers on your behalf and send you a “conditional payment” letter, itemizing those payments. Once a personal injury claim is settled, the settlement is reported to Medicare, who determines how much, if anything, is owed to them in repayment out of the settlement proceeds.
It is important to comply with Medicare’s reporting requirements and properly open and close a claim with Medicare. If this is not done or not done correctly, Medicare may choose to take action against you, including the withholding of social security benefits.
Medicare Reporting Applies Even If You Have A Replacement (Advantage) Policy:
A lot of Medicare beneficiaries have replacement (or advantage) plans through various providers like Blue Cross, Humana, United Healthcare, and People’s Health, to name a few. If you have one of these plans, Medicare simply pays the plan a set price every month on your behalf and then the plan itself pays the medical provider.
If you are in an accident and have a replacement/advantage plan, it is still important to report the accident to BOTH your health insurer and to Medicare. Even though Medicare usually doesn’t pay any medical bills directly, they still want to know about the accident and it is still important to open and close a claim with Medicare/CMS properly in order to remain compliance.
Medicare Even Cares About Future Medical Bills:
Even if you properly report and reimburse Medicare for any accident-related bills they paid on your behalf, it is important to evaluate whether you will require additional wreck-related medical treatment in the future. If so, Medicare doesn’t want to pay for it!
Instead, depending on the circumstances, Medicare may want you to put funds aside out of an insurance settlement, for the payment of your future accident-related medical expenses. This is called a Medicare Set-Aside (“MSA”). MSAs are more common in workers-compensation claims, but must also be considered in the context of a personal injury claim.
Have You Been Injured In A Car Wreck And Are A Medicare Beneficiary And Want To Make Sure You Stay Compliant?
If you have been injured in a car wreck and are a Medicare beneficiary and want to make sure you stay compliant following a car accident contact us online or call our Covington office directly at 985.590.6182 to schedule your free consultation today. Flattmann Law serves clients on the Northshore, including Covington, Mandeville, Abita Springs, Bogalusa, Franklinton, Folsom, Madisonville, Goodbee, Hammond, Lacombe, Pearl River, and Slidell.
