Unrelated Medical Expenses Part 1

Challenging Unrelated Medical Expenses on Medicare Liens Part 1

Liens leaving you unsettled? Personal injury attorneys often find that Medicare liens are often an obstacle to their client’s personal injury settlement. Attorneys who have experience with personal injury liens understand that the work that goes into negotiating a lien is complicated. If your client’s lien amount is much larger than expected, read on to learn how you can challenge the amount. Read part two to learn more.

Shocked By a Larger Than Expected Payout to Medicare?

Medicare will place a personal injury lien against your client’s personal injury case for the treatment received following an accident; however, sometimes these seem a bit exaggerated to both you and your client.

This can become a complicated issue for a client who is already utilizing benefits for pre-existing medical conditions during the same time period in which the client is receiving treatment for medical issues related to their personal injury claim. It may appear that after factoring in medical expenses owed to Medicare, your client may not be receiving much of a settlement afterall. Presumably, this would lead your client to wonder why they even pursued a settlement in the first place.

Identifying Unrelated Expenses

The medical costs related to your client’s personal injury claim are reimbursable, and Medicare has every legal right to pursue recovery. Unrelated medical costs, however, are a different story. As your client’s advocate, it is critical that you examine your client’s Medicare expenses to differentiate the legitimate expenses from the unrelated expenses. From this point, Medicare should reduce the personal injury lien amount and your client should be entitled to a greater settlement amount.

The Conditional Payment Letter

The Medicare Secondary Payer Recovery Contractor (MSPRC) will send your client a “Rights and Responsibilities” letter as well a Conditional Payment Letter. The Conditional Payment Letter will show the lien amount and a payment summary with every injury-related payment made on behalf of your client’s injuries. Each expense will be coded with an Internal Control Number (ICN) code which provides details for each expense. While examining each entry, you will be able to identify which expenses are unrelated to the injury claim by reviewing the date of the claim and other pertinent information.

For more information or to schedule a consultation, please submit our contact request form or call (877) 242-0022.

Disclaimer: The information contained in this article is for general educational information only. This information does not constitute legal advice, is not intended to constitute legal advice, nor should it be relied upon as legal advice for your specific factual pattern or situation.

TESTIMONIALS

"I just want to thank Synergy for their great work in getting a health insurance lien resolved. The health insurance company refused to reduce their lien a penny from a motorcycle accident involving my client who was not wearing a helmet, a fact that would have hurt our award in front of a jury. Synergy put tremendous pressure on this company, and after months of bombarding this insurance company with statutory requests and threats, they were able to get them to give in and reduce the lien significantly. The cost was minimal in relation to the hard work they put in, and the savings my client received. Client was very happy, and it allowed me to close out a case that I had resolved over 6 months before. Keep them in mind if you are dealing with a smug insurance adjuster who felt confident he would not have to reduce a lien, like I was dealing with. Thank you very much Synergy."

Jeffrey A. Adelman, Esq.
Adelman & Adelman, P.A.

"I have been very impressed by the results achieved by Synergy Lien Resolution Services. They saved my client over $108,000 in reducing a difficult ERISA lien. Their expertise was invaluable and resulted in a very happy client. Best money I ever spent. I wholeheartedly recommend them. You are doing your client a disservice if you don’t hire them to help you with your liens."

Armando Payas, Esq.
Payas Law

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