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.

Garretson Resolution Group Facebook Page

Leave a Comment