Medicare, Medicaid & Private Health Insurance Plans

Important Information about Healthcare Liens in Personal Injury Settlements

Under the laws of most states, when a personal injury claimant receives a settlement, he or she must use part of that settlement to pay back whoever paid for the medical care needed to treat his or her injury, whether it’s the government (i.e. Medicare or Medicaid), an employee health plan, or a private health insurance company. These healthcare “liens” or “reimbursement obligations” are now a part of almost all personal injury settlements. Claimants should take the time necessary to make sure they understand their healthcare benefits, obligations and rights. Doing so will ensure that healthcare provider’s interest are evaluated and resolved in the most efficient and favorable fashion as well as help provide for continued access to good care.

GRG specializes in settling healthcare liens and reimbursement claims with federal (Medicare), state (Medicaid) and private/ERISA health insurance providers in single event and mass tort settlements. In fact, GRG evaluated and resolved Medicare and Medicaid’s interest in over 100,000 cases last year alone. Simply put, we know the process.

In this booklet, we provide a guide to healthcare obligations faced by claimants and attorneys when settling personal injury cases. We breakdown the process and timeline and detail what claimants and their attorneys can do to help expedite the resolution of these obligations. However, if all of this seems overwhelming, you can skip to the question, “What can be done to ensure the most favorable result?” within each section which explains how GRG can take over this obligation. Our qualifications are rather straightforward: Knowledge, Experience and Compliance.


Among the “tips” are:

What is a lien? What are the different types of healthcare providers?

Medicare

  • What is it and what are the rules?
  • What are the different types of Medicare programs?
  • Do all of these Medicare plans have liens?
  • What is my reimbursement obligation to Medicare in a liability settlement?
  • How long does it normally take to resolve a medical lien? Why does it take so long?
  • What can I do to speed up the process?
  • Can I challenge or appeal Medicare’s lien?
  • Does Medicare have to pay any of the attorney fees and costs associated with my settlement?
  • What happens if I ignore Medicare’s lien?
  • What, if anything, must I do to preserve my Medicare coverage after a settlement?
  • What can be done to ensure the most favorable result?
  • What are the requirements for a Medicare “Set Aside?”

Medicaid

  • What is it and what are the rules?
  • What does “needs-based” mean?
  • What are the different types of Medicaid programs?
  • Are the Medicaid lien rules the same in every state?
  • What happens if I ignore Medicaid’s lien?
  • How long does it normally take to resolve a Medicaid lien?
  • What can I do to speed up the process?
  • Can I challenge or appeal Medicaid’s lien?
  • Does Medicaid have to pay any of the attorney fees and costs associated with my settlement?
  • What can be done to ensure the most favorable result?
  • What can I do to protect my SSI and Medicaid benefits after the settlement?

Employee Health Coverage

  • What is it and what are the rules?
  • What is your obligation as a beneficiary of an employee health plan?
  • What can be done to ensure the most favorable result?