Medicare and Your Oregon and Washington Injury Claim, Recent Developments

When Medicare pays some of your bills, and you have a an Oregon injury claim against a responsible party, the Medicare law provides that the liability insurance, no-fault insurance, or workers’ compensation must first pay for the medical care that Medicare would otherwise cover.

However, Medicare understands that liability insurance companies will not make advance payments on a personal injury settlement in many cases. Instead of having the medical bills remain outstanding, Medicare will make conditional payments while you pursue your auto injury claim. There is a catch.

Medicare will require that you reimburse it for the medical expenses it covered when you receive a settlement or award on your claim. In some cases, Medicare may agree to waive the amount it is owed, but you must file an appeal. Medicare will not do anything to seek collection from you while the appeals pending.

When we are involved in a case involving a Medicare subscriber, we provide the Secondary Payer folks with a copy of our fee agreement, and a signed release from our client, authorizing contact with Medicare. At the case’s conclusion, Medicare then provides a “demand” letter, seeking reimbursement of the amount it paid in benefits. In order to calculate the amount of the demand, Medicare will want to know the amount of your settlement, the attorney fees, and any cost that you incurred in pursuing your claim.

There have been a lot of problems working with Medicare, but recent changes have seen to help, somewhat. For example, on smaller cases, there is a possible election of paying 25% without calculating the actual lien. Also, where there is a settlement of $25,000 or less, Medicare may allow you to calculate the conditional payment amount so that the case can be moved forward more quickly.

Insurance companies are concerned about whether Medicare can seek reimbursement if the injured party fails to reimburse Medicare. There is some disagreement as to whether not insurance companies are required to report claims to Medicare.

Problems can come up, especially where some providers do not have all the billing information they need.  We also see issues where our client does not have a supplemental coverage plan.

If you have been injured in a Washington or Oregon auto collision, or if you have another injury claim, and Medicare’s involved, call us at 503-325-8600. We can answer your questions, and let you know where you stand.