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Are Medical Bills Fully Paid in A Settlement?

The Law Office Phillips & Allen PA Nov. 20, 2022

Not all medical bills are paid in full in these cases. That is not always the case. There are gaps, and it oftentimes depends on the value of the insured policy. Sometimes it becomes a responsibility of the victim, or the plaintiff to get those paid afterwards; so medical bills are not always paid in full. My goal is to always see what we can do to make sure there is enough in the settlement to cover those bills.

Will Reimbursement Include Medical Bills Already Paid And Future Medical Costs?

There are two types of damages that we are talking about now concerning medical bills. We refer to bills that have already been paid on behalf of the victim by their own insurance company. They usually have a lien, and it depends on the type of insurance company that has been paying those bills. I do not know the type of insurance company, but the type of policy that has been paying those bills, certainly ERISA health insurance will assert a lien to any responsible third party that caused those injuries if they paid into the healthcare loan. As to future medicals, I call them special damages.

We add special damage to enhance the value of the claim, and future medicals. In order for us to add for future medicals, we use a certified life care planner. In fact, I am reviewing a plan right now for an individual who was a victim in a serious dog bite case, where he was injured, and needs treatment in the future. He will also need surgeries in the future to fix nerve damage, but that is how you get to those future medicals. As to whether they are paid or not, it depends on how much the insurance policy is worth, or how much the defendant is worth. Finally, we ask how much of the future medicals can you directly link back to the incident.

It is a multi-step process you have to work through, but the life care planner is a key component of that, and they are a special expert, they are usually nurses that have been trained in creating life care plans based on the diagnosis and prognosis of the treating physicians. Oftentimes you will see treatment plans on diagnosis and prognosis in the discharge summaries, and the life care planner will take those statements, and work them into an ongoing or future medical care plan.

Is It Advisable To Pay Medical Bills As They Keep Coming In?

We look at that on a case-by-case basis if you should stay ahead of your medical bills. In general, I would say if it is covered with insurance, then you might as well pay. If it were a co-pay, I would say you might as well pay those too. Nevertheless, if there are significant bills, and you cannot pay them, then there is no use in trying to stretch to get those paid. We can often work out arrangements with the treating physicians, and the providers to wait for their bills to be paid at the conclusion of the case.

Many times, we can issue letters of protection to any treating providers, and ask if they will wait. Essentially, they assert a lien on proceeds, so before the victim can receive money, we have to guarantee the healthcare provider is going to be paid. We look at it on a case by cases basis as to whether you are going to pay them. Paying them in advance certainly enhances the value of their case, because those are out of pocket monetary funds already paid, as opposed to damages that are in the future that is somewhat speculative.

Which Providers Can Come Back To Recoup Bills Paid After A Settlement?

There are two big providers, but they are somewhat related to each other. Any Medicare or Medicaid funds are going to be subjected to reimbursement. That reimbursement process is a special term called Subrogation. When your insurance company pays you money or pays money on your behalf to a third party, if you are able to recover for those injuries and damages, they are entitled to their proportion of the money that you get back, since they are out of pocket loss due to someone else’s conduct. The companies that are always entitled to reimbursement are Medicare, and Medicaid, and then collateral from that are the state welfare departments, the similar circumstances to Medicare or Medicaid.

Those people always get their money back. Finally, it is the federal ERISA act, but what that means is any insurance company that is a fully funded plan through ERISA is entitled to their money back, that is a federal law. For example, some states will say that there is no right of subrogation for money that was paid on behalf of an auto accident by an insured. It is pre-emptive by federal law. Therefore, if it is paid on behalf of a fully funded ERISA qualified plan, then they get their money back, even though the state law says that is not the case.

It is Medicare, Medicaid that run their recovery efforts through a company called Centers for Medicaid Services, then DPW liens, Department of Public Welfare, Department of Welfare, Maryland Mental Health Department, which is the acronym for Maryland’s Health Department. I want to say it is like a mental, health and hygiene department. Department of Mental and Hygiene for Maryland want their money too, and then ERISA plans will want their money as well. There is a way to check online. There is a way to check to determine whether your employer is reporting, and they are required to report a form to social security to see if that is the case as to whether there is an ERISA plan, that is how we find out.

How Long Does It Take To Receive Damages After A Settlement Is Achieved?

Receiving damages after a settlement takes about thirty days. The only thing that would delay that is verification of statutory liens. For example, Medicare liens that we discussed earlier have to verify those before monies can be distributed, but that is really about it.

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