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  1. #1
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    Feb 2020
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    Default Will Medicare Pay Hospital Bills During a Law Suit

    My question involves an injury that occurred in the state of: Louisiana

    My wife is a case manager at a hospital here in louisiana and she runs across cases where Medicare will refuse to pay a patients medical bills if they have filed a personal injury suit. When Medicare runs their social security number and see that a suit has been filed, then medicare places the bill burden on the offending party..In my case, I am attempting to initiate a suit against Round up weed killer
    for Lymphoma cancer..I have talked to a couple of attorneys, and have been told different, that Medicare will pay the bills during the course of the suit but now I need further advice. Has any one run across this in the past?

    Has anyone had trouble getting Medicare to pay bills during the course of a law suit? I would hate to file a suit and then have to go back for treatment in a month and not be able to get the bills paid. Is my wife wrong? Does anyone have any suggestions besides just listening to an attorney say go with it? thanks

  2. #2
    Join Date
    Jun 2006
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    Massachusetts
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    Default Re: Will Medicare Pay Hospital Bills During a Law Suit

    When you called Medicare and asked them what their policy is on the subject, what did they say?

  3. #3
    Join Date
    Mar 2013
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    17,604

    Default Re: Will Medicare Pay Hospital Bills During a Law Suit

    Your claims are likely to be paid during the lawsuit but Medicare will have an automatic lien on any settlement or award and will be reimbursed for any bills paid for your treatment.

    See the search results at:

    https://duckduckgo.com/?t=ffab&q=med...y+claim&ia=web

  4. #4
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    Feb 2020
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    Default Re: Will Medicare Pay Hospital Bills During a Law Suit

    Thank you for the replies...It is impossible to find someone at Medicare that knows this information..Medicare employees, or at least the ones that you can get on the phone, don't know anything...There is no such thing as calling a Medicare Attorney, they don't do that ..The attorneys that I have talked to about filing the suit agree that Medicare will pay during the course of the suit But my wife doesn't agree...So I guess the next step would be to stop a couple of other hospitals and see if I can find some one in billing or another case manager that could verify what my wife is saying....

    I have researched the Medicare set side programs, and your link "thank you" I think I will try to find a Hospital forum or similar, and see if I can dig up more info that way , I will post back and let you know what I find.. One other interesting thing I have found is the fact that there is not necessarily any written law when it comes to some of these suits, especially the Round up suits...They just go by what a previous jury voted on, that is a close to law as you can find, I guess...but that's the way they are doing it..and that's why you can't find info..

  5. #5
    Join Date
    Jun 2014
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    3,143

    Default Re: Will Medicare Pay Hospital Bills During a Law Suit

    The link below should be helpful.

    https://www.cms.gov/Medicare/Coordin...nsurerServices

  6. #6
    Join Date
    Feb 2020
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    5

    Default Re: Will Medicare Pay Hospital Bills During a Law Suit

    Excellent, thank you , this is what I have been looking for..After reading the documentation, it seems that my wife is correct, and during a lawsuit
    where liability insurance is involved, then the offending party's insurance would be responsible for paying the bills, that is why she can't get people qualified
    for medicare payment during the course of the suit.. so how do you suppose
    the bills get paid? I am asking here because 9 out of 10 law people that you talk to when you ask them don't know.. para legals mostly.. They must have some other method set up with Medicare to settle this thing, surely Medicare is not going to turn down billions of dollars.......This is what I need to find out, and if the suit happens then I surely would like to see it in writing..

  7. #7
    Join Date
    Mar 2013
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    17,604

    Default Re: Will Medicare Pay Hospital Bills During a Law Suit

    Quote Quoting shovel52
    View Post
    it seems that my wife is correct, and during a lawsuit where liability insurance is involved, then the offending party's insurance would be responsible for paying the bills, that is why she can't get people qualified for medicare payment during the course of the suit..
    That doesn't make any sense. Filing a lawsuit or even making a claim against a party you believe to be at fault doesn't mean anybody will ever see any money. Neither the party or his/her/its insurance is obliged to pay anything until a court of law says so or until there is a settlement.

    According to the link provided by M&G:

    However, the MSP provisions allow Medicare to pay conditionally for a beneficiary’s covered medical expenses when the third party payer does not pay promptly.
    I realize that there may be a HIPAA issue but can your wife produce redacted denial letters from Medicare? After all, from the patient to your wife to you to us is fourth hand information.

    That's about the only way you will see it in writing until you file a Medicare claim while your lawsuit is in progress.

  8. #8
    Join Date
    Feb 2020
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    5

    Default Re: Will Medicare Pay Hospital Bills During a Law Suit

    Yes, you are right, It doesn't make any sense, and it was the first thing that I thought of when she told me that.."what happens if we lose?" She does get a denial letter, it is the EOB "explanation of benefits letter" and basically Medicare may still be responsible for the bill, but it can postpone any treatments for as long as the suit is in progress, leaving patients without treatment ..This just sounds like a big flaw in the system and to me also sounds typical. Sounds like Medicare is getting left behind on some of these hospital bills. It also sounds like Round up weed Killer and medicare need to work together to make this settlement work, Round up is offering 8 billion dollars to get every one off their back.

    I have not been able to find a law firm, "even a firm that specializes in the Round up cases" that will say different, most of the para legals on the phone , don't know, and then you will hit one that says " your medicare benefits will not be effected at all" scary, that is why I want to research this myself first.

    At this point I am just going to hang in there and maybe someone here will know a firm that is actually handling a Round up case and can answer this, I am going to keep calling attorneys until I find one. One other interesting fact here is the question..How do you know that weed Killer caused the cancer in the first place? my doctor said that he thinks it was the Epstein Barr virus...It doesn't matter, since a jury has already awarded several winning cases then that is what they are going with..Congratulations on this forum, this is a very relaxing and enjoyable forum. Hopefully my questions have not been too vague..I am just as confused as everyone else, I am not an attorney. I know there is an answer.

  9. #9
    Join Date
    Feb 2020
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    2

    Default Re: Will Medicare Pay Hospital Bills During a Law Suit

    First of all, this is relevant to my experience in Maryland. Second, all of my experience is either from auto accidents, or other specific liability events, with a definite date and cause of loss.

    yes, Medicaid will pay for bills while you are being treated, but they will put a lien on the settlement because they deserve to be paid back.

    So many things wrong/weird about this thread.

    First of all, how would Medicaid know there's a lawsuit?
    Second, there isn't a lawsuit until you have determined that out-of-court settlement negotiations will not come to an agreement. You have to purposely start a lawsuit, which is not easy.
    Third, insurance companies will not negotiate until treatment has either been finished, or a long-term outcome is apparent (I.E. you will need medical oxygen for the rest of your life).
    An insurance company cannot negotiate with unknown medical expenses. As a result, when you are in negotiations with the insurance company, they request access for all medical records. At this point, they will contact Medicaid (who insured you), and will alert Medicaid of the claim. Medicaid then determines how much money they want back, and put a lien on your account that must be satisfied prior to receiving any funds.

    So this is like a weird, circular, non-starter situation that wouldn't happen. Medicaid will not pay for medical expenses because it's a lawsuit --> but you can't have a lawsuit without providing medical records to the insurance company --> but you can't get medical records due to no treatment, so....

  10. #10
    Join Date
    Feb 2020
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    5

    Default Re: Will Medicare Pay Hospital Bills During a Law Suit

    I did get a call back from an attorney online and he explained like this. Yes Medicare can run your social security and see if you have a pending lawsuit, and Medicare can refuse to pay the bill, but he said he has never seen it happen because there are third party companies hired by Medicare that do nothing but make sure that Medicare is paid no matter what the procedure is. I think this explains why I am getting two different sides to this story. My wife says as a case manager she sees it, and the Attorneys say they never see it, Two different attorneys say that they have done numerous of these type of suits but
    when they get to this section they have to refer you to a different department if you want it explained to you. I seem to be the only person in the world
    that does. If my wife was not a case manager then I probably wouldn't have known either..This guy said , if it does happen, then you can just drop the suit.

    Yes , first is provide medical records, and see if you qualify, second is examine to see if there is any rewards, "is it worth while" and then third is try to settle first before you file the suit. not sure about all the future stuff, "Medicare set a sides" that's the attorneys job.....So, I think there is some kind of problem in billing" paper work" between Medicare and the hospitals, and these companies that work for Medicare, kind of an insurance for Medicare.
    I have one other law firm that is supposed to call me back this week, if he explains it like the guy above then That should be enough for me.

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