Question

A 68 year old patient, a Medicare beneficiary, was in a car accident. A medical insurance claim was filed with the auto insurance carrier. Six months later this claim remains unpaid. How can the provider pursue payment from Medicare?

Answer 1

In case an auto insurance claim for a Medicare beneficiary remains unpaid, the provider should file the claim with Medicare following their guidelines, including timely submission and providing evidence of non-payment by the auto insurance.

Step-by-step explanation:

When a Medicare beneficiary is involved in an automobile accident, their medical claims may be initially addressed to the auto insurance carrier. If such a claim remains unpaid after six months, the provider can pursue payment from Medicare. Considering Medicare as a secondary payer, the provider should submit the claim with appropriate documentation showing that the auto insurance has not paid the claim. It is essential for the provider to follow Medicare's guidelines for timely filing, which typically involves submitting claims within a year from the date of service. By doing so, the provider can secure reimbursement from Medicare, ensuring the patient receives necessary medical care without undue financial hardship.