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Dealing With CMS After A Florida Accident


As of this writing, millions of people in Florida have Medicare and/or Medicaid coverage. Medicare is for the disabled and for individuals over the age of 65, while Medicaid covers many more people, though it may not cover certain procedures. Most of the time, these programs are used in the context of paying for care proposed by a person’s doctor – but in some situations, Medicare or Medicaid may be used to help cover the medical bills after an auto accident. If you are in this situation, it is crucial to understand how to properly deal with the Centers for Medicare & Medicaid Services (CMS), so that you have the best chance of ensuring your expenses are paid.

Florida Is A No-Fault State

If you are involved in a Florida auto accident, the first thing you should determine is the true extent of your injuries, which means seeking medical treatment as soon as possible. In Florida, most auto accident cases wind up not in front of a judge, but as a claim with one’s personal injury protection (PIP) insurer, unless the potential plaintiff has sustained a “significant and permanent” injury, such as the loss of a limb. Florida is a no-fault state for purposes of auto insurance, which means that all auto accident claims which do not result in serious injury must be settled by filing a claim under your PIP insurance.

That said, Florida law only requires a driver to carry a minimum of $10,000 in PIP coverage, plus $10,000 in property damage liability insurance. You have the option to carry more, but most do not bother. $10,000 may not last very long in terms of covering medical bills, depending on the severity of your injuries, and in addition, PIP coverage will only cover up to 80 percent of all “reasonable expenses” for “medically necessary” care – which is a definition that can be highly subjective.

Primary vs Secondary Payers

If you run through your PIP coverage and any other coverage (such as any private health insurance), your doctors may choose to bill Medicare or Medicaid, depending on which coverage you have. In this situation, Medicare and/or Medicaid are known as secondary payers. If you are involved in an auto accident, your PIP coverage would be a primary payer, as well as any private health insurer you have, or if your accident occurred while you were on the job, your employer’s workers’ compensation insurer would qualify as well.

When these options are exhausted, Medicare or Medicaid may make conditional payments if they are necessary. Conditional payments create what are known as Medicare (or Medicaid) liens. Essentially, if Medicare pays some of your medical bills after an auto accident, it expects to be repaid out of other funds (most often, a personal injury award, if you file suit and prevail) because it is only a secondary or conditional payer. Depending on the specific case, it may be possible to appeal Medicare or Medicaid’s requests for repayment via CMS, particularly if you do not prevail in your suit; however, negotiating with CMS is not a job for a layperson. An experienced attorney can help.

Contact A Tampa Auto Accident Lawyer

Negotiating with insurance can seem extremely overwhelming in the weeks and months after a serious car crash. However, a Tampa car accident attorney from the Rinaldo Law Group can help try to clarify what your options may be, and how best to interact with CMS so that you can minimize your financial obligations. Contact our offices today at (813) 831-9999 for a free consultation; we are ready to try and assist you with your case.


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