Medicare & Lien Amount Calculations

Question: My client is not a Medicare beneficiary but BCN Insurance is claiming a lien. Are other insurance companies required to follow the same lien calculation formula that Medicare uses to determine the amount of the lien?

Answer: If your client was Medicare entitled but chose to receive Medicare benefits through a Part C plan (also known as Medicare Advantage) then there is a strong presumption that the Part C provider (private insurer or corporate entity) should follow the same standards followed by CMS, including a procurement offset under 42 CFR 411.37. If you would like more information on Medicare Part C and their rights of recovery please click here.

If coverage was provided in another capacity (not Part C) by a private insurer then the reductions will be governed by the type of private plan (ERISA, government employee, individual policy, etc) and the applicable rules of that type of plan (state, federal, contract etc). Depending on the type of plan and your jurisdiction there may or may not be an obligation to reduce for a procurement offset.