Medicare Advantage Plans and you NC Injury Claim

This is what you’re going to hear from me when you tell me that – in addition to your Medicare coverage – you have a Medicare Advantage Plan.

 It appears you have a Medicare Advantage plan that in some way supplements your Medicare coverage.  Many of these plans have what’s called a “right of reimbursement” or “subrogation” claim.  That means that in a situation where we obtain for you payment in compensation for incurred medical expenses from an at-fault party, then your health plan may have a right to get paid back what they paid out.  Normally if this is the case, they or a company they hire, reach out to you to investigate this.  To date, I’ve not been apprised that this has happened.  I can’t effectively investigate this with your plan.  It would be most wise for you to contact your health plan, make this inquiry – does the plan have a right of reimbursement for third party claims? – and let me know the response.  Failure to do so can leave you owing them after your settlement money is gone, and can impact your coverage as well.  Please let me know what you discover.

Why is that important? Well, if they have the right to get paid back from your settlement and we don’t do it, then that can jeopardize your coverage and create legal troubles for you. That’s no bueno.

Why do I ask you to do it? It’s the simplest way to get it done. They won’t speak with me if they don’t have a release on file. And these different companies have their own (sometimes asinine) interpretations of HIPAA law so I can’t guarantee they’ll accept a release I send them. So the safest bet is for you, the insured, to reach out and get the answer we’re looking for. They have to tell you, and if they don’t, then document it and it’s their fault.

This stuff is needlessly complicated. Welcome to America!

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Jeffrey Allen Howard, Attorney at Law, PLLC
1829 E. Franklin St. - Bldg 600
Chapel Hill, NC 27514

(P) 919-929-2992
(F) 919-636-4779

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