Anyone know does Medicare subrogate/pay bill for MVA until insurance pays?

  1. Last Sunday my elderly parents (80's) were in an awful wreck. They got hit and their car spun several times and then flipped. Unbelieveable, once the firemen were able to get them out they were able to walk away. I am still in awe of God's awesome power. Their car was totaled.

    They both have Medicare. The kid who hit them has liability only insurance. My dad's left leg is completely numb up to the hip. His doctor wants him to have an MRI and physical therapy. The kid's insurance company won't pay the medical bills until the case is settled, which as we all know, can take quite some time. My parents don't have the money to pay for these items up front. I know private insurance companies pay the bills and then make you sign to pay them back as soon as the case is settled. Does Medicare do this also. Does anyone know? Does anyone know the best way for me to handle this? I believe it's called subrogation when the insurance company pays and then waits to be repaid when the case has been settled. Thanks for any help you can offer me.
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  2. 2 Comments

  3. by   NRSKarenRN
    medicare subrogate/pay bill for mva until insurance pays.

    faciliy/doctor need mva accident and lawyer info; facility/doctor send bill to mva carrier for payment or denial then bills medicare as secondary payer.

    see:

    10.20
    [color=#231f20]injuries covered by auto/no-fault or liability insurance

    [color=#231f20]
    (enacted 12/1/80)--value code 14 or 47
    [font=timesnewroman,bolditalic][color=#231f20]
    msp manual
    [color=#231f20](cms pub. 100.5, ch.2 40.3b & 60; ch.3 30.2.1; and ch.5 20.1)
    [color=#231f20]
    [color=#231f20]
    for injuries involving auto or liability insurance, medicare is secondary. auto insurance is the beneficiary's own insurance they carry on their own automobile or the automobile in which they are a passenger. liability insurance is the insurance that provides payment when responsibility is established for injury or illness. no-fault insurance pays medical expenses for injuries sustained on the property or premises of the insured or in an automobile, no matterwho was at fault. examples of no-fault insurance include auto no-fault and homeowners medical payment
    insurance.

    medicare will pay claims conditionally for all auto or liability insurer claims; that is, medicare will pay first and request a refund of any overpayment after the auto or liability insurer has paid. you may request a conditional payment if you know an auto or liability insurance is involved. refer to 60, "additional instructions for msp situations," later in this section for specific information on when to file these claims.
    https://www.cahabagba.com/part_a/edu...erials/msp.pdf
  4. by   DutchgirlRN
    Thank you Karen, you're the bomb! I had a feeling you would be the one with the answer I need. This is very much appreciated!

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