Medical Malpractice, Medicare Supplemental Insurance

Posted by Matthew Garretson

Question:
I am handling wrongful death case in which Medicare paid some bills and United Healthcare Insurance Company, a supplemental insurance carrier purchased through AARP, paid some of the bills. Can anyone tell me whether the supplemental carrier, United Healthcare, has a right of subrogation against the proceeds of our case?

-Missouri Attorney

Answer:
Medicare Supplemental Insurance is still just insurance – it has no federal rights of recovery and is governed by state insurance law under McCarran-Ferguson. See 42 C.F.R. 403.201; V.A.M.S. 376.859. Under Missouri law in this case, subrogation or reimbursement of medical expenses is prohibited. See Jones v. Aetna, 497 S.W.2d 809 (Mo.App.1973); Waye v. Bankers Multiple Line Ins. Co., 796 S.W.2d 660 (Mo.App. W.D. 1990). As such, UHC should not have an enforceable right of recovery or reimbursement from the settlement proceeds.

I hope this information helps. Mark Taylor in my office heads up our private health / ERISA lien resolution practice. He might be able to offer more insight on how to deal with them if you get push back.