Millions of Americans have health insurance through Medicare, either because they are receiving Social Security Retirement benefits, Social Security Disability Insurance benefits, or Supplemental Security Income benefits. In many ways Medicare coverage is very similar to private health insurance coverage, but there are also many distinctions. While most employers and individuals purchasing private health insurance agree to terms and conditions of coverage in a contract, traditional Medicare coverage is based upon federal statutes and regulations. For the reasons below, at Koederitz Law Firm, we always urge our injured clients to use their Medicare coverage to pay medical expenses related to their injuries.
Medicare laws provide that if another person causes you to incur medical expenses, such as treatment for an automobile accident, then the automobile insurance of the person who caused your injury is primarily responsible for payment of your treatment expenses. However, government administrators also recognize that in many states, such as Louisiana, the liability insurer of the driver who negligently causes a collision does not have to pay your bills until the conclusion of your claim. To avoid making its beneficiaries wait until the end of a case to begin receiving their treatment, the Medicare laws allow for what are called “conditional payments.” These conditional payments are made by Medicare to provide treatment to the injured accident victim, but comes with the requirement that the expenses paid by Medicare be reimbursed to Medicare from any settlement or judgment at the conclusion of the case. If you are a Medicare beneficiary, you can therefore receive all of the treatment that you need because of an accident, paid for by Medicare. When a settlement is made, or a judgment is rendered after a trial, a part of the claim should be recovery of medical expenses incurred. These funds are then returned to Medicare so that, by the conclusion of the case, the insurance company for the driver that caused your injuries was also responsible for the medical expenses that were incurred.
Medicare beneficiaries in Louisiana have an important advantage they should not overlook if injured in an automobile collision, or in any other way by a third party. All of the healthcare providers that treat you will have a certain “retail” price for their services. However, by law and regulations, Medicare will pay a lesser amount to those providers pursuant to a schedule. Thus, the total amount that Medicare actually pays will be a lesser amount than the “billed” or retail amount of the charges for services. In Louisiana, the Supreme Court has ruled that a negligent driver, or any third party who injures you through their fault, does not get to take advantage of the discount that Medicare enjoys by law. Thus, in Louisiana, the law allows an injured accident victim to recover the total billed or retail amount of all charges for medical treatment from the insurance company of the negligent driver or other person who injured you. You will then reimburse Medicare only the smaller, discounted amount which it was required to pay. Furthermore, Medicare recognizes that most injured individuals need the assistance of an attorney, and Medicare will further reduce its claim against any settlement proceeds to reflect the expenses incurred by the injured victim, including attorney fees, in collecting his or her damages. This further reduction which Medicare grants is generally about one-third of the total amount it has paid. Thus, for example, if a patient incurs $3,000.00 in billed charges for physical therapy, based upon the schedule, Medicare may pay only $1,200.00. If that were the only medical expense in the case, then a settlement would be made with the insurance company for the negligent driver which would include $3,000.00 in physical therapy expenses. From those settlement funds, the injured client would then reimburse Medicare about $900.00, or two-thirds of $1,200.00. At Koederitz Law Firm, we have had some clients who have had retail medical expenses that were $50,000.00 or more above the amount Medicare asked to be reimbursed. Those clients received significantly higher net settlement funds than if they had either paid the billed amount themselves, or agreed to simply pay the doctor in full at the conclusion of treatment. Thus, this is the reason that we always recommend that our clients use their Medicare coverage to pay medical expenses resulting from a crash or other accident.
If you have been injured in an automobile accident, or any other kind of accident in Louisiana, we urge you to consult with an experienced Louisiana lawyer. Gary P. Koederitz has represented individuals in claims for personal injury for over thirty years. At Koederitz Law Firm, we are here to assist you and guide you through the process of obtaining proper medical treatment, establishing the fault of the person who caused your injuries, collecting all of the necessary evidence to prove your claims, and brining your case to a satisfactory conclusion. Please call us today at Koederitz Law Firm, (225) 295-9494, for a free consultation regarding your automobile accident.