Q&A: Private Plan Rights & Reimbursement Obligations

Question: My client has a claim for a dog bite. She is covered by Blue Cross Blue Shield as a retired teacher and has an LPPO Plan on behalf of Medicare. Nothing shows up on Conditional Payment Online for her medicals for Medicare. Do I need to call BC/BS? Is this a Medicare Part C Plan?

Answer: As your client is both Medicare enrolled and is enrolled in a private health insurance plan, and the federal government is telling you that it has not paid anything for conditional payments on behalf of its beneficiary, it’s a good bet that the private plan is the one that has been paying the bills to date. However, to understand with certainty the plan’s rights and your client’s obligation to reimbursement that plan for past medicals, a review of the plan language is critical. Our private/ERISA group can assist you further in this matter.

Visit http://web.garretsongroup.com/Private-Health-Insurance-ERISA-Hospital–Provider-Liens for more information.




What Happens to Medicare Set Aside Proceeds Upon a Claimant’s Death?

Question: I have a Workers’ Compensation claim with a 78 year old claimant who is contemplating a $130K settlement of which $6904 of it is the Medicare set aside (MSA) to be be paid out in lump sum. Claimant self administers. He realizes he must spend down and account for his medical expenses. The concern…


Join GRG’s John Cattie at the South Carolina Advanced Workers’ Compensation Seminar – August 5th


Friday FAQ: The Effect of No Fault Coverage on MSP Compliance

Question: I was an attendee at a recent conference where an attorney from GRG spoke. He talked about factors you should consider when deciding whether a client needs an MSA or not, and documenting the file if you decide an MSA is not required. In making that decision, does the amount of No Fault coverage a…


50% Off CLE Courses for AAJ Annual Convention

Heading to the AAJ Summer Annual Convention this weekend? We’ll be there at booth #706 so be sure to come by and talk liens and medicare set asides with us! We’ll have our Subject Matter Experts there to answer any questions you may have, PLUS you’ll have a chance to win a free Kindle Fire. We’re…