Medicare, Medicaid, and TriCare
Medicare, Medicaid, and TriCare or CHAMPUS all have a statutory right—or clear legal right—to repayment from your settlement for any amount they paid on your behalf.
Each of these agencies gets paid back in different ways and sometimes with very different sets of rules. The basic rules for repayment are:
- Medicare
Since Medicare is a federal program, it gets paid first out of any settlement. As a general rule, Medicare must reduce its lien by one-third for attorney fees, but otherwise, Medicare has the right to full repayment. Medicare repayment can take many of the settlement proceeds before anything else is paid. In an attempt to reduce the amount repaid to Medicare, we often resort to appeals for a waiver or reduction of the lien. - Medicaid
In North Carolina, Medicaid repayment is secondary to Medicare. Medicaid is treated the same as a “valid lien holder“, which means that North Carolina Medicaid—together with the other valid lien holders—can recoup no more than one-third of the settlement proceeds, no matter what amount it paid in your case. - TriCare (CHAMPUS)
As TriCare—formerly known as CHAMPUS—is governed by federal law, your North Carolina auto accident attorney will typically contact legal counsel through the Judge Advocate General’s office in the military to determine and negotiate your lien with legal counsel for the government.
In many cases, our clients have a combination of Medicare, Medicaid, and TriCare, which can complicate repayment from your settlement. Our North Carolina auto accident attorneys want to make sure you pay these agencies back correctly because failure to do so can result in stopped benefits and even prosecution.
Why Use Health Insurance?
In most cases, the North Carolina auto accident lawyers at Henson Fuerst recommend that you submit all medical bills to your health insurance company, even if you may have to pay the insurance company back later.
Submitting your bills to your health insurer gets your bills paid sooner so that you don’t have balances for large outstanding medical bills throughout your case. While some cases may only take a couple of months to resolve, in larger injury cases, or cases where a lawsuit has to be filed, it can take years to resolve.
Just because you have a pending legal case doesn’t mean that a medical provider can’t demand payment or turn you over to a collections agency if your bills are not paid in a timely manner.
Once your case is resolved, our North Carolina auto accident attorneys typically have the ability to negotiate or reduce the claims from your health insurance company. This means that you may only be responsible for a percentage of what the company actually paid. We also can help you determine if the insurance company’s claim to repayment is valid.
In the very rare case that you decide against submitting a medical bill to your insurance, make sure you review the bill with your Raleigh auto accident lawyer. We’re here to protect your rights to compensation.
Get the help you need today—get Henson Fuerst. Call us now at (919) 781-1107 or complete a free initial consultation form. At Henson Fuerst, our experienced North Carolina Car Accident attorneys will review every detail of your case and fight hard to ensure that your rights are protected.
