Med Mal / Medicare

Posted by Matthew Garretson

Question:
I have a 73-year-old client who was rear-ended in a motor vehicle accident. He eventually has a Lumbar Laminectomy; his insurance co-tenders UM policy limits of $100,000 prior to any suit being filed. No BI available. His total medical bills are $148,000. Can he submit medical bills to Medicare that exceeded his available UM policy limits? At this point, no bills have been submitted to Medicare, all his medicals are on LOP's.

-Florida Attorney

Answer:
Absolutely. A client's personal insurance is considered primary to Medicare. Both underinsured motorist and uninsured motorist are included in the definition of liability insurance for Medicare reimbursement purposes. If the limits of the UM policy have been tapped, Medicare would now be primary.

Keep in mind however that some Medicare providers have up to 27 months to submit bills to Medicare for payment. So, if some of those providers submit their bills to Medicare and Medicare pays (even after the UM policy limits are tendered), Medicare would have reimbursement claims for services that they paid for that occurred between date of injury and date of tender of UM.

Hope this info helps.