Medigap Claim Paid then they get a Settlement Offer

[somarco]

Client slip & fall in a retain outlet. Medicare and Medigap paid.

Some time later the store liability policy offered a lump sum settlement. Now Medicare has issued a demand for payment letter to my client. So far, she has not had a demand from the Medigap carrier.

Does anyone know if the Medigap carrier will also ask for repayment?

 

[ValeRosso]

As far as I am aware supplements are not considered a Medicare program benefit under the MSP so they have no lien rights for settlement.

 

[goillini52]

As far as I am aware supplements are not considered a Medicare program benefit under the MSP so they have no lien rights for settlement.

The Med Supp pays a % of what Medicare pays, so if Medicare gets reimbursed, the Med Supp company should get back a % of what Medicare gets back.

 

[somarco]

the Med Supp company should get back a % of what Medicare gets back.

The operative word is "should" . . . my question is this . . . who notifies the Medigap carrier that the Medicare claim payment was adjusted due to the settlement?

 

[goillini52]

The operative word is "should" . . . my question is this . . . who notifies the Medigap carrier that the Medicare claim payment was adjusted due to the settlement?

Please note:​

"Communication with Medicare's recovery contractor is usually handled by attorneys or representatives. Please discuss MSP issues with your attorney before contacting Medicare's recovery contractor or before using the Medicare Secondary Payer Recovery Portal."

I would think that since Medicare notifies the carrier when they've paid on a claim, that they would also notify the carrier of a recovery claim................but I don't know.

 

[yorkriver1]

Hmmm, just had a client lose Medicaid from an accident lump sum settlement. Not sure if anything accident related was carved out in medical billing, etc. Had to change from a DSNP to MAPD, with no additional benefits from income/assets. There was an attorney involved, not sure about any behind the scenes notices to Medicare.

 

[LostDollar]

Please note:​

"Communication with Medicare's recovery contractor is usually handled by attorneys or representatives. Please discuss MSP issues with your attorney before contacting Medicare's recovery contractor or before using the Medicare Secondary Payer Recovery Portal."

I would think that since Medicare notifies the carrier when they've paid on a claim, that they would also notify the carrier of a recovery claim................but I don't know.

I am not an agent.

I don't know either.

But my don't know response would be the opposite of yours, because I'm thinking --- somewhere, once while reading crosswalk stuff, I saw a note that Medicare would only crosswalk the original service claim, but would not crosswalk subsequent stuff if there were followon modifications to the claim.

I don't know if I am remembering that correctly or incorrectly and I also don't know if specific rules for crosswalk of claims also apply to Medicare cost recoveries.