See that dog? I normally get that look from my clients when I try to explain this. Bear with me…
When you receive Medicare, and when you have a third party that might also be responsible for your medical bills (like when you have an injury claim that results in an offer of money, part of which reimburses you for medical expenses), then the law requires that you pay Medicare back.
But like anything dealing with government, the process isn’t straight forward. Not the end of the world, of course, it’s just more hoops to jump through. What are those hoops? I’m so glad you asked:
First, you’ll need to notify Medicare of the third party claim. As your attorney, I’ll do that for you, but I’ll first get you to sign a MSPRC/Medicare Proof of Representation form. That allows them to talk to me.
Second, Medicare will send what they call a Conditional Payment letter that indicates what they’ve paid in relation to your claim. This is NOT the final number that you’ll owe them, but it is IS what you have to work with in negotiating the claim with the third party.
Of course, if there are things listed in that summary of the Conditional Payments that you don’t think are related, we can ask them to amend it. They often will, which is nice.
AFTER we settle the claim (yes, AFTER) we then submit a form to Medicare indicating what the claim settled for, what the attorney’s fees were, AND what else we have to pay out of the settlement (other bills, costs, etc.). About a month or two later (that depends…years ago it was an 8 month turnaround, but as of this writing, they’ve been doing it in 1 – 2…) they send the Final Settlement letter, telling us what they want back. In calculating that number, they take into account the fees/costs/etc. that we reported, so often times this number is less than the Conditional Payment amount, but not always (as some payments can occur after the CP $…).
More complicated than it needs to be? Probably. But it’s what we have to work with for now, and it’s all the more reason to NOT handle your case on your own. Failure to take Medicare’s interest into account can jeopardize your coverage. Call me! 919-929-2992.