Monday, October 26, 2015

Do Hospitals Have to Accept Medicare After an Auto Accident in Las Vegas, Nevada?

Having Medicare can save you a lot of money on monthly insurance bills. If you have Medicare, you may think that you can simply show your Medicare and supplemental insurance cards to the hospital after a traumatic car accident, and expect Medicare to pay the bill. However, it would surprise many Medicare recipients to know that the hospitals are not required to bill Medicare after a car accident.

According to federal Medicare law, a hospital has the option to bill Medicare for the treatment you received as a result of a car accident. However, they can choose not to bill Medicare and instead wait for the proceeds of the personal injury settlement to pay your hospital bill. See Medicare Secondary Payer Manual, Chapter 2, section 40:  

40.2 - Billing in MSP Liability Insurance Situations 

A - Difference Between Liability Insurance and Other Primary Plans 

Liability insurance differs from the other insurance policies or plans that, under §1862(b) of the Act, are primary to Medicare. In the case of other types of insurance that are primary to Medicare, i.e., no-fault insurance, group health plans, and workers' compensation, the insurance has a contractual obligation to pay for medical services provided to the covered/injured person. Liability insurance, however, has a contractual obligation to compensate the alleged tortfeasor for any damages the alleged tortfeasor must pay to an injured party. 

B - Billing Options and Requirements - Alternative Billing 

Generally, providers, physicians, and other suppliers must bill liability insurance prior to the expiration of the promptly period rather than bill Medicare. (The filing of an acceptable lien against a beneficiary's liability insurance settlement is considered billing the liability insurance.) Promptly means payment within 120 days after the earlier of: 1) the date the claim is filed with an insurer or a lien is filed against a potential liability settlement; or 2) the date the service was furnished or, in the case of inpatient hospital services, the date of discharge) rather than bill Medicare. Following expiration of the promptly period, or if demonstrated (e.g., a bill/claim that had been submitted but not paid) that liability insurance will not pay during the promptly period, a provider, physician, or other supplier may either:
    •    bill Medicare for payment and withdraw all claims/liens against the liability insurance/beneficiary's liability insurance settlement (liens may be maintained for services not covered by Medicare and for Medicare deductibles and coinsurance); or
    •    maintain all claims/liens against the liability insurance/beneficiary's liability insurance settlement. 

The above Medicare manual says that after 120 days of non-payment, a hospital can bill Medicare for your hospital bill. However, that is a choice that a hospital can make. Instead, the hospital can simply wait for your case to settle and get paid through the settlement proceeds. 

If you read my prior blog on health insurance, you will know that pursuant to Nevada law, if you have health insurance, the hospital must bill the health insurance first. However, if you have Medicare as your primary ‘health insurance’, this law does not apply. The reason for this, is that Medicare is governed by Federal law and Federal law trumps State law. 

If your hospital chooses not to bill Medicare for your hospital bill, your injury attorney will work with the hospital’s collection agency that tries to collect payment directly from you. Your injury attorney will request that all collections efforts are put on hold until your personal injury case is resolved and payment can be made through your personal injury settlement.

Next time, we will discuss whether health insurance companies can be reimbursed for medical bills they paid after a Las Vegas car accident.

Thursday, October 8, 2015

Can Someone Get PTSD After a Serious Personal Injury in Las Vegas, Nevada?

After being involved in a serious accident or injury event, many people continue to feel anxiety or fear. If you have been through a traumatic injury or witnessed a fatality in a car accident, these feelings are common. This is called post traumatic stress disorder or PTSD for short. If you are wondering if you could be suffering from PTSD after a serious accident or injury, here is some information to guide you:

PTSD: Post Traumatic Stress Disorder

PTSD can present itself through continued feelings of Anxiety, Stress, or Fear, that simply will not go away. These symptoms are one of the most common reactions to a traumatic event. At the time of the event, you may have an overwhelming experience of fear-- of being physically injured or even of being killed. This can and oftentimes does carryover after the trauma has stopped. Common symptoms of PTSD include:
    •    Being afraid to go anywhere where a similar event can take place.
    •    Feeling anxious all the time.
    •    Stressed with even the smallest of tasks.

Fear responses associated with the event (to certain sights, sounds, smells, thoughts, etc.) can persists for weeks, months, or even years. People who have been part of a serious accident or injury, typically avoid anything which reminds them of the event (places, situations, people, etc.). Some people become so fearful that they greatly restrict their activities, even to the point that they are unable to leave their homes or to be left alone.


Another reaction to an extremely traumatic event, is the feeling of helplessness. Some common types of responses are:
    •    Feel helpless to stop the event.
    •    Feeling hopeless about the present.
    •    Feel hopeless about whether anything can be done in the future.

A common symptom people experience after a traumatic event, is to re-experience the event. This vivid symptom is called a flashback. People re-experience the event over and over again in their thoughts and in their dreams. These flashbacks make you feel like the event is happening all over again. Proper psychological counseling can lessen the occurrence and intensity of flashbacks.


One of the most common reactions after a serious accident or injury is depression. Feelings of unrelenting sadness and unhappiness, that prevent you from living life the way you did before the event, may indicate that you are suffering from depression. Depression can include feelings of hopelessness and despair. You may having frequent unprovoked crying spells or even contemplating suicide. Losing interest in daily activities that you used to enjoy, is also another sign. 

Problems Concentrating

A very common symptom after a traumatic event, is not being able to stay focused on the task at hand. Trouble concentrating is a common refrain from people after a traumatic event. This ability to stay focused can feel frustrating and add to the sense of loss of control.

The best thing to keep in mind is that effective therapy is available if you are suffering from PTSD. Your experienced personal injury attorney will be able to help you get the medical care you need, to put you on the road to recovery.

Next time, we will discuss whether health insurance companies can be reimbursed for medical bills they paid after a Las Vegas car accident.