Medicare + P&C Liability Insurance

[somarco]

Client injured in a retail store . . . provider filed claims with Medicare which were paid by Medicare and the Medigap carrier.

Months later the store liability coverage kicked in and paid at least a portion of the medical claims. My assumption is Medicare will subrogate against the P&C carrier for reimbursement. How about the Medigap carrier? Will they also seek reimbursement from the P&C carrier?

The P&C carrier also offered a settlement to cover potential future claims. How will Medicare handle those claims?

 

[goillini52]

Client injured in a retail store . . . provider filed claims with Medicare which were paid by Medicare and the Medigap carrier.

Months later the store liability coverage kicked in and paid at least a portion of the medical claims. My assumption is Medicare will subrogate against the P&C carrier for reimbursement. How about the Medigap carrier? Will they also seek reimbursement from the P&C carrier?

The P&C carrier also offered a settlement to cover potential future claims. How will Medicare handle those claims?

I assume Medicare will be reimbursed, as Medicare pays secondary in these cases.

 

[somarco]

I assume Medicare will be reimbursed, as Medicare pays secondary in these cases.

I told her Medicare would subrogate against the P&C carrier to recoup what they paid for claims. Unless Medicare notifies the Medigap carrier of the situation I doubt there will be any funds returned to them.

My question involves the settlement to cover potential FUTURE related claims. How will Medicare, and the providers, know if the client has settlement funds to be used for paying future claims.

Seems like a bit of a mess. I know when automobile carriers have liability it can take a long time before they settle and then the claim dollars are redistributed again.

 

[goillini52]

I told her Medicare would subrogate against the P&C carrier to recoup what they paid for claims. Unless Medicare notifies the Medigap carrier of the situation I doubt there will be any funds returned to them.

My question involves the settlement to cover potential FUTURE related claims. How will Medicare, and the providers, know if the client has settlement funds to be used for paying future claims.

Seems like a bit of a mess. I know when automobile carriers have liability it can take a long time before they settle and then the claim dollars are redistributed again.

I've seen people get forms from Medicare to fill out to see if somebody besides Medicare should pay 1st....like slipping on ice while walking into a store. I'm sure there must be a form for this somewhere.

 

[grod]

The parties involved know that your client is on Medicare. They will notify Medicare of the settlement. Medicare uses a formula to calculate their cut of the settlement amount which will be used to cover future claims, which will be paid by Medicare.

 

[somarco]

The parties involved know that your client is on Medicare. They will notify Medicare of the settlement. Medicare uses a formula to calculate their cut of the settlement amount which will be used to cover future claims, which will be paid by Medicare.

How about bills incurred and paid by Medicare prior to the settlement?

Does Medicare recapture those dollars from the provider or the patient?

 

[grod]

This may provide the answer you are looking for: [EXTERNAL LINK] - Reimbursing Medicare | CMS

 

[somarco]

This may provide the answer you are looking for:

Thanks! I was looking for that the other day and most of the results pointed me to MSP (Medicare Secondary Payer) or COB with auto insurance.

Probably similar but this involved slip & fall in a retail store, so dealing the the CGL policy, not auto.

 

[yorkriver1]

This is interesting and informative, thanks. I heard a couple years ago there was a lawsuit filed by a Medicare beneficiary with a MedSupp for a slip and fall at a church. Of course the initial bills must have been paid by Medicare. Never heard anything about further about the situation.