Legal Question in Personal Injury in New York
What is Medicare saying?
Medicare sent me a copy of a letter sent to my insurance company:
Medicare has been advised that you may be the responsible payer for the above beneficiary for matters which occurred as a result of the above referenced illness/injury date.
The purpose of this letter is to advise you of the applicability of the Medicare Secondary Payer Laws. Per 42 U.S.C. 1395y(b)(2)and 1862(b)(2)(A)(ii)of the Act,Medicare is precluded from paying for a beneficiary's medical expenses when payment ''has been made or can reasonably be expected to be made...under Workers'Compensation plan,an automobile or liability insurance policy or plan(including self-insured plan)or under no-fault insurance.''Medicare may make conditional payments in accordance with Medicare's prompt payment guidelines.
Interest may be assessed,if Medicare is not repaid in a timely manner for conditional payments made. Repayment of Medicare's conditional payments must be made to the local Medicare contractor or the lead contractor handling this case.The attached release must be signed in cases where Medicare has made conditional payments and Medicare must release specific claims payment data to you for settlement purposes.
What does it all mean?
2 Answers from Attorneys
Re: What is Medicare saying?
Basically what this means is that Medicare is a "secondary payer",so that if there is any other insurance available to you, such as workers compensation or no fault, that other insurance would be primarily obligated to pay for your medical expenses. Nevertheless, if Medicare does pay for medical expenses and you are reimbursed from any source, they are entitled to be promptly repaid for those payments. Other sources can mean other insurance or settlements from lawsuits. Hope this helps. Please feel free to contact me with any further questions you may have.
Re: What is Medicare saying?
Medicare must have information that this either occured as the result of an auto accident or Work related injury that will trigger "other insurance."
It means that youy need to have the subject medical bills sent to the correct insurance company, and establish a claim with that company. That is your responsibility and medicare is informing you that you can end up personally liable if you don't.
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