I read this recent story about stalls with Medicare reimbursements. This, like the Social Security hearings backlog, is a significant problem for Oregon and Washington personal injury victims.
As the American population ages, the number of people on Medicare increases. If a retired person on Medicare is injured in an auto accident, or due to the fault of another, Medicare may end up paying some of the medical expenses. Medicare is health insurance, but it is provided by the federal government. But here is the problem.
Let's say you are injured in a car wreck in Oregon. If you have auto insurance, your insurance will pay medical bills up to a certain amount, and over a certain period of time. Right now, it's $15,000.00 or one year. But let's say you are injured seriously enough to have to stay in the hospital, or even worse, have a surgery. Then, chances are, your medical bills are going to exceed what your Personal Injury Protection provides. If this happens, your health insurance will take over, and pay your bills.
Any health plan that pays bills to an accident victim that is seeking compensation is going to want to be paid back. So if your health care plan paid bills, and you make a claim, if you recover on that claim, you are going to have to reimburse the health plan for the benefits it provided. Put another way, you and your health plan are in the same boat; you both have suffered a loss. Most plans require reimbursement, because it does not want to pay for medical care caused by another insurance company's negligent insured. This is what we in the law call "subrogation."
Medicare is like any other health care plan. It pays your medical bills, and if another insurance company's insured caused the injuries, it is going to want its money back. The problem with Medicare is that it takes so long to tell you how much it wants for reimbursement. Private health plans will provide this information in a number of days, but with Medicare, it takes months.
When we have a client insured by Medicare, it can take several months to get a reimbursement figure, and this can cause a delay in getting a settlement paid to our clients. We try to anticipate the amount Medicare paid by reviewing the explanation of benefit forms, and itemized Medical bills. Still, if there is a discrepancy, Medicare can go after everyone involved.