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Law Educator, Esq.
Law Educator, Esq., Attorney
Category: Personal Injury Law
Satisfied Customers: 111492
Experience:  Licensed Attorney. Over 20 years experience in personal injury and law enforcement.
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Can hospitals and doctors collect on medical liens if the

Customer Question

Can hospitals and doctors collect on medical liens if the patient has Medicare and they choose to do a lien rather than bill Medicare for treatment after patient was injured in an auto accident? If so should patient ask for that amount be included when figuring out of pocket expenses?
Submitted: 6 months ago.
Category: Personal Injury Law
Expert:  LawTalk replied 6 months ago.

Good afternoon,

I'm Doug, and I'm very sorry to hear of your situation. My goal is to provide you with excellent service today.

There are several categories of doctors and hospitals that accept Medicare. They are either Participating doctors/hospitals, Non-participating doctors/hospitals or Opted Out.

For Opted out providers, they do not have the right to bill Medicare for anyone. So based on your facts I presume that the doctor/hospital is either Participating or Non-Participating.

A participating provider must accept your Medicare if you offer it and they are limited to what they may charge based on Medicare service tables.

A non-participating provider may choose to either bill Medicare or bill the patient up to an additional 15% 15% above the cost of the service as determined by Medicare may be charged.

So, if you want to force the issue, and even if you signed a lien, you can demand that the provider either bill only Medicare if they are Participating, or if Non-participating, bill you no more than 15% above what Medicare would pay them.

You may reply back to me using the Reply link and I will be happy to continue to assist you until I am able to address your concerns, to your satisfaction.

I hope that I have been able to fully answer your question. As I am not an employee of JustAnswer, please be so kind as to rate my service to you. That is the only way I am compensated for assisting you. Thank you in advance.

I wish you and yours the best in 2016,

Doug

Expert:  LawTalk replied 6 months ago.

Good afternoon,

Do you have any additional questions that you would like me to address for you?

In case you would like a phone call to further discuss these issues you have raised, I will make that offer to you. You are certainly not obligated to accept a call offer, but many people do find it helpful for clarification purposes, as well as to allow them to ask additional questions.

As I have provided you with the information you asked for, would you please now rate my service to you so I can be compensated for assisting you?

Thanks in advance,

Doug

Customer: replied 5 months ago.
It appears the way I phrased my question was unclear. I understand
Participating or Non-Participating Medicare providers. When I
went to the hospital for treatment, they asked the cause of my
compliant and I gave them the accident information. I don’t
remember if I gave my Medicare information. They are a
Participating Provider, but filed a lien, and per Medicare they can
only back bill for up to a year and that date has pasted. So
my question was not whether thy can charge above the Medicare
service tables, but because they didn’t submit to Medicare originally,
are they not allowed to receive any compensation, and as I was 66
at the time of the accident, should they of asked if I was covered by
Medicare? Would not seem right that they would not be compensated
at the Medicare rate. So when giving my out of pocket cost I would
think I have to pay at least the Medicare rate on the lien.
Expert:  LawTalk replied 5 months ago.

I am unable to further assist you in this matter, and I am going to opt out of your question and open this up for other professionals.

Your question is being placed back in the question list for other professionals to see, and to respond to. You do not have to stay online for the question to be active. Should another professional pick it up, you should be alerted by email unless you actively disable this feature.

There is no need for you to reply at this time as this may "lock" your question back to me, thus inadvertently delaying other professionals' access to it.

I apologize for any inconvenience and wish you well in your future.

Doug

Expert:  Law Educator, Esq. replied 5 months ago.

Thank you for your question. I look forward to working with you to provide you the information you are seeking for educational purposes only.

I am a DIFFERENT CONTRIBUTOR as your previous contributor had to leave.

If the provider is a medicare provider and failed to ascertain you were covered by medicare and failed to submit the bills for your care in time to medicare, this is a violation of medicare rules which can subject the provider to suspension or sanctions from medicare for violating medicare rules. In addition, this negligence in failure to determine if you are a medicare covered patient, the rules say it is the provider's duty to determine this, and negligence in billing, you would have the right to actually sue them for negligence since had they properly submitted the bill as required you would have been covered and would have only had to pay what was not covered at the medicare rates. So you need to send them a letter informing them of this negligence and that you will report their negligent billing practices to medicare for investigation and demand they waive the bill except for the amount you would have had to normally pay under medicare rates had they properly submitted the claim as they were supposed to do in a timely manner.

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