Mike Bonamarte on TLV

Hello, Fellow Trial Lawyers!

In the latest episode of Trial Lawyer View, Jason Lazarus sits down with Mike Bonamarte from Levin & Perconti. They delve into Mike’s landmark Illinois jury verdict of $40 million dollars. Together, they discuss the intricate details behind the substantial verdict, shedding light on the medical malpractice claims and the profound impact of Keira’s birth injuries. Mike’s strategic insights illuminate the factors that influenced the jury’s decision, emphasizing the power of Kiera’s testimony in shaping the final outcome. Through this episode, Mike emphasizes the importance of challenging preconceived notions and inspires listeners to pursue justice for their clients relentlessly, regardless of jurisdiction.

Listen now.

Do Hospitals and Providers Have to Bill Insurance, Including Medicare and Medicaid?

Teresa Kenyon, Esq.

Introduction

The landscape of healthcare billing can be complex and confusing, both for healthcare providers and patients alike. When there is third-party liability involved, such as in cases of accidents or injuries caused by someone other than the patient, the responsibility for billing insurance can become even more complex.  In these situations, a hospital may explore various avenues to determine the primary source of payment for the medical services provided. One common question that often arises is whether hospitals and healthcare providers are obligated to bill insurance, particularly government programs like Medicare or Medicaid. In this post, we will explore healthcare billing, the role of insurance, and the requirements associated with billing Medicare and Medicaid generally and in third-party liability cases.

The Basics of Healthcare Billing

Healthcare billing is the process by which healthcare providers submit claims to insurance companies or government programs to receive payment for the services they render to patients. Health insurance, whether private or government-sponsored, plays a crucial role in covering medical expenses and ensuring access to healthcare services for covered individuals.

Providers are generally encouraged to bill insurance companies to facilitate the reimbursement process and reduce the financial burden on patients. However, the decision to accept insurance and the specific agreements between providers and insurers can vary.

Do Hospitals and Providers Have to Bill Insurance?

In the United States, there is no federal law mandating that hospitals or healthcare providers must bill private insurance, Medicaid, or Medicare. Providers have the flexibility to decide whether they will accept insurance and enter into agreements with specific insurance plans for the amount of those payments for specific services. While it’s customary for healthcare providers to bill insurance, including Medicare and Medicaid, some may choose not to participate in certain networks or programs. However, this decision can have implications for both the provider and the patient, as non-participating providers may charge higher fees, leaving patients responsible for a larger portion of the bill.

Typically, hospitals initiate billing by submitting claims to the primary health insurance for the medical services rendered. This is a standard practice, and hospitals typically bill the patient’s insurance as part of the normal billing process. In situations involving third-party liability, the hospital may engage in a process known as Coordination of Benefits. This involves determining the order in which multiple insurance policies will contribute to covering the patient’s medical expenses. The hospital may work with the patient’s primary insurance provider, and if applicable, the insurance provider who represents the at-fault third party.

The hospital will likely conduct an analysis balancing how they receive the largest payment for their services in the shortest period of time. While the hospital works through the billing and coordination process, the patient may still be responsible for co-pays, deductibles, or any charges not covered by insurance. Clear communication between the hospital and the patient about financial responsibilities is crucial.

Billing Medicare: An Overview

Medicare, a federally funded program, provides health coverage for individuals 65 and older and certain younger individuals who suffer from specified disabilities. Providers can participate in the Medicare program or be non-participating providers, though this is uncommon.

Participating providers agree to accept Medicare-approved amounts as full payment for covered services, and they submit claims directly to Medicare. Non-participating providers may charge more than the Medicare-approved amount and may require patients to pay the difference, known as “balance billing.”

It’s important to note that while providers are not required to participate in Medicare, they are prohibited from discriminating against Medicare beneficiaries. This means that providers cannot refuse to treat a patient solely because they are covered by Medicare.

When the payment for treatment is someone else’s apparent responsibility, the provider has an obligation to not bill Medicare. Under the Medicare Secondary Payer Act, Medicare may not pay for a beneficiary’s medical expenses when payment “has been made or can reasonably be expected to be made under a workers’ compensation plan, an automobile or liability insurance policy or plan (including a self-insured plan), or under no-fault insurance.”[1] However, if responsibility for the medical expenses incurred is in dispute and other insurance will not pay promptly, the hospital, provider, physician, or other supplier may bill Medicare as the primary payer.

Billing Medicaid: An Overview

Similarly, by law, the Medicaid program is the “payer of last resort.” If another insurer or program has the responsibility to pay for medical costs incurred by a Medicaid-eligible individual, that entity is generally required to pay all or part of the cost of the claim prior to Medicaid making any payment. This is known as “third-party liability” or TPL. Third parties that may be liable to pay for services include private health insurance, Medicare, employer-sponsored health insurance, settlements from a liability insurer, workers’ compensation, long-term care insurance, and other State and Federal programs (unless specifically excluded by Federal statute).

Problems can arise when a provider decides they would rather be reimbursed from a beneficiary’s tort settlement.  A provider may make this decision if it suspects it would be entitled to a higher reimbursement amount than it would receive from Medicaid.  This does not always work out in the provider’s favor if the settlement amount ends up not being enough to satisfy the provider’s claim.  Typically, providers have only 1 year from the date of service to submit bills to Medicaid. 

Navigating the Billing Process

Patients should be proactive in understanding their insurance coverage and seeking clarification from providers about their billing practices. It is advisable to confirm whether a healthcare provider accepts the insurance, including Medicare or Medicaid, and inquire about any potential out-of-pocket costs. Being informed and seeking in-network providers can significantly alleviate the complexities of the billing process.

No Surprises Act

The No Surprises Billing Act, officially known as the No Surprises Act, is a U.S. federal law enacted as part of the Consolidated Appropriations Act, 2021. It addresses the issue of surprise medical billing, a situation where patients receive unexpectedly high medical bills, often due to receiving care from out-of-network providers, even in emergencies or situations beyond their control. The act aims to protect patients from exorbitant bills for out-of-network healthcare services, particularly in emergency situations and certain non-emergency situations.

Key provisions of the No Surprises Billing Act include:

  • Patients are protected from surprise billing in emergency situations, where they have little or no control over the choice of healthcare provider, by limiting their out-of-pocket costs to in-network amounts.
  • In situations where insurers and providers cannot agree on reimbursement rates for out-of-network services, the No Surprises Act establishes an Independent Dispute Resolution (IDR) process. This process involves an independent third party reviewing and resolving disputes between healthcare providers and insurers regarding reimbursement.
  • The Act requires healthcare providers and insurers to provide patients with a good faith estimate of the expected costs for scheduled services, allowing patients to better understand and plan for their healthcare expenses.
  • Patients are protected from balance billing for out-of-network emergency services and certain non-emergency services provided at in-network facilities.

The No Surprises Billing Act primarily focuses on protecting patients from unexpected and excessive medical bills, and it does not specifically address third-party liability situations in the traditional sense. However, its impact on third-party liability scenarios can be seen in the context of emergency care and situations where patients have limited control over the choice of healthcare providers.

In cases of emergency care, where patients may not have the opportunity to choose in-network providers, the No Surprises Act helps protect patients from balance billing and ensures that their out-of-pocket costs are limited to the amounts they would pay for in-network services. While the No Surprises Act primarily addresses disputes between insurers and providers, the IDR process could potentially be used in certain third-party liability situations where disagreements arise over reimbursement for medical services.

Conclusion

In the complex world of healthcare billing, there is no universal requirement for hospitals and providers to bill insurance, including Medicare or Medicaid. The decision to participate in insurance programs is often at the discretion of individual providers. In normal situations, patients should advocate for themselves by being informed about their insurance coverage, seeking in-network providers when possible, and clarifying billing arrangements with healthcare providers. In third-party liability situations, planning is often not possible. However, the No Surprises Billing Act should add a layer of protection, preventing unexpected billing surprises for patients whether or not available insurance is billed, or the hospital maintains a debt or asserts a lien.

[1] 42 U.S.C. §1395y(b)(2).

Joe Mechlinski on TLV

Hello, Fellow Trial Lawyers!

Don’t miss out on the latest episode of Trial Lawyer View! Join Jason Lazarus as he sits down with Joe Mechlinski from SHIFT. In this episode, Jason delves into the realm of law firm team performance and engagement with Joe. Joe highlights the critical role of organizational culture in fostering high-performing legal teams, emphasizing the importance of removing barriers and blockers that hinder success. Through innovative approaches like SHIFT and tools like Latch, Joe provides insights into optimizing team engagement and productivity. He challenges traditional notions of work hours, advocating for flexibility to empower law firm employees to do their best work. With Joe’s expertise, listeners gain valuable insights into creating a supportive environment that unleashes the full potential of legal teams.

Listen now.

Thanks for listening!

Jason D. Lazarus, Esq.

Damages in Personal Injury Lawsuits

Rasa Fumagalli, JD, MSCC, CMSP-F

Personal injury lawsuits seek to secure compensation for individuals who have suffered harm due to the negligence of others. Although injured parties can never be fully made whole, for personal injury attorneys it is important to highlight all of the various damages injured parties have suffered when negotiating settlements. This article will focus on the future medical expenses and how to maximize their recovery.

Future Medical Damages

Determining the future medical expenses in a case is pivotal in assessing damages, crafting arguments, and ultimately securing just compensation for the injured party. Central to this process is the use of Medical Cost Projections (MCPs), a tool that forecasts the potential healthcare expenses incurred due to an injury.

Medical Cost Projections entail a meticulous evaluation of the injured party’s medical history, prognosis, treatment plans, and anticipated healthcare needs. By leveraging medical records, MCPs aim to forecast the future expenses directly and indirectly attributable to the injury sustained.

The methodology involved encompasses a multifaceted approach. It involves analyzing past medical bills, considering potential complications or additional procedures, and factoring in rehabilitation and long-term care costs. Additionally, MCPs rely on Standard of Care and Evidence-Based Medicine guidelines to project costs accurately.

Standard of Care (SoC) and Evidence-based Medicine (EBM) Guidelines

SoC guidelines represent a benchmark defining the level of care, treatment modalities, and diagnostic approaches that healthcare professionals are expected to provide for patients suffering from a specific medical condition or undergoing a particular procedure. These guidelines are formulated by medical societies, expert panels, and healthcare regulatory bodies based on a thorough review of available evidence, best practices, and expert consensus.

SoC guidelines encompass a spectrum of recommendations, covering diagnostics, treatment options, follow-up care, and expected outcomes for various medical conditions. They serve as a framework for healthcare providers, outlining the most appropriate and effective approaches to patient care based on the current understanding of the medical field.

EBM, on the other hand, forms the cornerstone of clinical decision-making, emphasizing the integration of the best available evidence from systematic research with clinical expertise and patient values. It involves critically appraising scientific literature, clinical trials, meta-analyses, and other sources of empirical data to inform medical decisions.

The core principles of EBM revolve around the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. It encourages healthcare practitioners to evaluate the validity, reliability, and applicability of evidence before incorporating it into clinical practice.

In the realm of Medical Cost Projection, SoC guidelines and EBM significantly influence the accuracy, reliability, and comprehensiveness of cost projections. Here’s how they intertwine within MCP reports:

  1. Treatment Protocol Adherence: MCP reports rely on SoC guidelines to outline the expected course of treatment for a particular medical condition or injury. Adhering to these guidelines ensures that the projected costs encompass treatments that are considered standard and appropriate within the medical community.
  2. Validity of Projections: Evidence-based approaches underpin the validity of MCP reports. By aligning projections with empirical evidence derived from studies, clinical trials, and accepted practices outlined in SoC guidelines, MCPs maintain credibility in estimating future medical expenses.
  3. Effectiveness of Interventions: SoC guidelines, based on evidence, often highlight the most effective interventions or treatments. MCP reports factor in these interventions to project costs accurately, reflecting the expenses associated with evidence-supported treatments and expected outcomes.
  4. Rationale for Projections: Incorporating SoC guidelines and EBM into MCP reports provides a rationale for the projected costs. It establishes a clear link between the anticipated medical expenses and the recommended evidence-backed treatments and interventions.
  5. Dynamic Nature of Evidence: EBM acknowledges the evolving nature of medical knowledge. MCP reports must consider updates and revisions in SoC guidelines and emerging evidence to ensure projections remain aligned with the latest evidence-based practices.

In personal injury cases, adherence to SoC guidelines and EBM principles in MCP reports strengthens the medical damages arguments. It substantiates claims regarding the necessity and reasonableness of projected medical expenses, providing empirical support for the damages sought on behalf of injured individuals.

Value of Medical Cost Projections in Personal Injury Cases

MCPs offer profound value and serve multiple critical purposes in settlement negotiations. First, they provide a tangible framework for assessing damages. Furthermore, attorneys armed with precise projections can devise long-term strategies, including structuring settlements to cover future medical expenses adequately. This foresight safeguards clients from being under-compensated and helps in securing resources for continued care and rehabilitation.

 Synergy is here to help you quantify the future medical damages portion of your case. Our attorneys and nurses have the knowledge as well as expertise to help maximize the recovery.  Contact Synergy today to learn more about how our MCP report can simplify the negotiation of future medical care for your case.

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Craig Goldenfarb on TLV

Hello, Fellow Trial Lawyers!

Join Jason Lazarus in a very special 30-minute episode of Trial Lawyer View! 🌐 Craig Goldenfarb from GOLDLAW shares invaluable law firm business tips. In this episode, you will get Craig’s Law Firm CEO Insights like:

💼 Discover Craig’s role and how he runs his personal injury law firm like a business.

🏛️ Leadership and Structure: Uncover the secrets behind his firm’s leadership dynamics.

💡 Firm Business Essentials: Learn the top 5 things every trial lawyer should know about running a law firm as a business.

🤝 Law Firm Culture: Explore the importance of culture and aligning compensation.

📊 Data Analytics: Craig reveals how he leverages data for success for his law firm, sharing key metrics.

Don’t miss this super-focused powerhouse episode! 🚀

Thanks for listening!

Jason D. Lazarus, Esq.

Top Cases for Lien Resolution

Teresa Kenyon, Esq. and Kevin James

Effectively minimizing or eliminating the reimbursement of any claimed medical lien is a critical part of ensuring just compensation for the injured. Personal injury lawyers encounter numerous obstacles in the process of resolving liens. While the negotiation and resolution of liens can be done independently by the attorney and their teams, collaborating with a seasoned lien resolution expert can alleviate these challenges. The obstacles a personal injury lawyer may face encompass time-consuming tasks such as identification of lienholders, navigating the intricate web of jurisdiction-specific lien laws, and negotiating for the most substantial reduction possible. Confronting these challenges may prevent attorneys from focusing on what the firm does best and distract from the primary task of representing more clients successfully.

If you decide not to outsource lien resolution functions to experts, the following noteworthy precedents will serve as valuable guides in your efforts to minimize liens. The applicability of these cases for lien resolution depends on the unique context of the case and differences from jurisdiction to jurisdiction. Nevertheless, these cases have played a substantial role in shaping lien resolution principles in their respective areas.

Medicaid – Arkansas Department of Health and Human Services v. Ahlborn (2006):

Ahlborn was a landmark case that has played a pivotal role in establishing the principle of “proportional recovery” in Medicaid lien reduction. The Supreme Court ruled that Medicaid can only recover from the portion of settlement dollars that can reasonably attributed to medical expenses. The mandate from the Court is that an allocation must be made between medical expenses and all other types of damages.  The parties agreed to a pro-rata reduction prior to the Court’s ultimate holding in Ahlborn, but it is most important to note that the Court expressly refused to mandate a method of allocation, only that an allocation must be done.

Medicaid – Gallardo v Marstiller (2022)

The Court provided additional clarification regarding the previous limitations for reimbursement to Medicaid as espoused by Ahlborn by holding that the Medicaid Act permits states to seek reimbursement from settlement payments allocated for future medical care, not just past medical care.

ERISA – Cigna v Amara (2011)

This case focused on whether the employees could enforce the terms of the ERISA Plan based on misleading SPDs, even if the terms of the Plan and the SPDs did not align. The Supreme Court ruled in favor of the employees, holding that the terms of an ERISA plan could be enforced based on equitable remedies when there was a discrepancy between the plan documents and the SPDs. The Court clarified that, under ERISA, the terms of the plan documents govern, but if there is a conflict or discrepancy between the plan documents and the SPDs, the actual plan terms controlled.

ERISA – US Airways, Inc. v. McCutchen (2013):

The US Supreme Court held that while ERISA plans are contractual, and their terms are generally enforceable, equitable doctrines can sometimes be invoked to limit the extent of reimbursement sought by a plan. The Court ruled that when a plan seeks reimbursement from a participant’s recovery, the common-fund doctrine and unjust enrichment principles can be considered to ensure fairness. However, the Court also emphasized that the specific terms of the Plan and the intent of the parties, as expressed in the plan documents, should guide the analysis. The Court remanded the case to the lower courts to apply these equitable principles in determining the extent of reimbursement owed to the ERISA plan, taking into account the circumstances of the case. While used by subrogation vendors as their support for why they don’t have to reduce their self-funded ERISA lien, it is also strongly support for the injured party when the policy language is not clear and concise.

ERISA – Montanile v. Board of Trustees of the National Elevator Industry Health Benefit Plan (2016):

Montanile focused on whether the ERISA health benefit plan could enforce its subrogation rights to recover funds from Montanile’s settlement after he had spent the settlement proceeds on nontraceable items.  The Montanile decision clarified the limitations on health benefit plans’ ability to enforce subrogation rights in certain circumstances. It emphasized the importance of timely action by plans to assert their rights and highlighted the challenges plans may face when seeking recovery from participants who have already spent settlement funds on general expenses.

Hospital/Provider – Howell v. Hamilton Meats & Provisions, Inc. (Cal 2011):

California Supreme Court case that addressed the issue of medical cost recovery in personal injury lawsuits. In this case, the court held that a plaintiff in a personal injury case could only recover the reasonable value of medical services actually provided, as opposed to the higher billed amount. The decision clarified that the “collateral source rule” did not allow plaintiffs to recover medical expenses greater than the amount actually paid for the services, typically negotiated down by health insurers. This ruling had implications for the calculation of damages in personal injury cases, limiting the amount plaintiffs could recover for medical expenses.

Medicare – Bradley v Sebelius (11th Cir 2010)

The 11th Circuit Court of Appeals dealt a significant blow to Medicare’s reimbursement practices under the Medicare Secondary Payer Act. The ruling, stemming from a case challenging Medicare’s ability to recover from the portion of the settlement dollars intended to compensate the heirs for their damages under Florida’s Wrongful Death Act’.  This holding establishes that the Medicare Secondary Payer Act does not preempt the Florida Wrongful Death Act and that Medicare was limited to the funds allocated to the survivorship claim.

Medicare Advantage – In re Avandia (3rd Cir 2012):

The first court to conclude that a Medicare Advantage Plans rights under the Secondary Payer Act are identical to those under traditional Medicare. Unfortunately, some subrogation vendors for Medicare Advantage plans have twisted this and subsequent cases to mean that they have the same right to make a recovery but then do not believe it means that they have the same liabilities or requirements for reduction or compromise as traditional Medicare.

Conclusion

In conclusion, effectively managing and minimizing medical liens in personal injury cases is a multifaceted and evolving challenge. The landscape of lien resolution is continuously shaped and redefined by significant legal precedents, such as Ahlborn, Gallardo, Amara, McCutchen, Montanile, Howell, Bradley, and the Avandia case. These rulings collectively underscore the necessity for personal injury attorneys to be acutely aware of the nuanced and jurisdiction-specific legal frameworks governing medical liens.

For attorneys, these cases serve as essential guides in navigating the complex terrain of medical lien resolution. They offer strategic insights into negotiating lien reductions, understanding the scope of lienholders’ rights, and leveraging equitable doctrines to contest excessive claims. More importantly, these rulings underscore the importance of precise and informed decision-making in the resolution process.

The evolving legal landscape, characterized by these landmark cases, reinforces the value of collaboration with experienced lien resolution professionals. While personal injury attorneys possess the legal acumen to represent their clients effectively, partnering with lien resolution experts can provide the specialized knowledge and strategic insight necessary to navigate this complex area efficiently. Such collaboration not only maximizes the potential for reducing liens but also allows attorneys to focus on their core competency—advocating for their clients—thereby enhancing the overall effectiveness and success of their legal practice.

Partner with Synergy for lien resolution services here.

Bryan Smith on TLV Podcast

Hello, Fellow Trial Lawyers!

In the latest podcast episode of Trial Lawyer View, host Jason Lazarus engages in a captivating conversation with Bryan Smith from Tamaki Law. Bryan’s unique blend of psychology and trial law expertise shines as he shares his journey in the legal profession. “You start to connect those dots, and it all starts to make sense” Bryan reflects on connecting the dots and highlighting how understanding trauma can make one a more effective advocate. Discover the profound impact of Bryan’s psychology background on his advocacy for victims of sexual abuse, medical malpractice, and wrongful death. “That’s what gets the best result for the client: confidence that the truth will prevail, that we are going to be able to tell this story in a way that really impacts the jurors on an emotional level,” Bryan passionately emphasizes. Gain insights into his expert strategies for maximizing recoveries in automobile accident cases and the challenges faced when representing survivors in sensitive cases. Bryan’s passion for the arts also parallels the challenges of trial lawyers, making this episode a compelling exploration of law, psychology, and justice. Don’t miss this engaging conversation.

Thanks for listening!

Jason D. Lazarus, Esq.

Why Personal Injury Attorneys Should Partner with Lien Resolution Experts?

November 9, 2023

Teresa Kenyon, Esq.

Introduction

In the world of personal injury law, every moment counts. The intricacies of building a solid case, negotiating with insurance companies, and advocating for your clients in court demand your undivided attention. Yet, there’s a persistent issue both during and after resolution of your case that often distracts you from your core responsibilities: healthcare liens. These liens, imposed by healthcare providers, government agencies, and private insurers, can become a legal labyrinth which negatively impacts the amount your injured clients will receive. This is precisely why collaborating with a dedicated Lien Resolution Specialist can be a game-changer for your practice.

We will explore the compelling reasons why you should outsource your lien resolution work to experts. We will delve into the complexities of different types of healthcare liens and how seasoned Specialists can positively impact your clients’ take-home recovery.

Understanding Healthcare Liens

Before probing into the reasons why you should engage experts for lien resolution, let’s take a step back and understand the nature of healthcare liens.

Healthcare liens are legal claims placed on a personal injury settlement or judgment by healthcare benefit providers. These liens aim to recover the medical expenses paid for by the health benefit program that were incurred by the injured party as a result of the accident or injury. The types of healthcare liens come in various forms including:

Medicaid Liens:

State-administered Medicaid programs that provide healthcare coverage to low-income individuals. When Medicaid beneficiaries are injured due to someone else’s negligence, state Medicaid programs may assert liens to recover the medical costs they’ve covered. Medicaid liens can have a substantial impact on personal injury settlements. However, case law, such as the Ahlborn and Gallardo decisions, have established the principle of proportional recovery. This means they should only claim a fair share of the settlement or judgment amount.

Medicare Liens:

Medicare is a federal program that provides healthcare coverage primarily for individuals aged 65+ and older or in specific other situations. When Medicare beneficiaries are injured, Medicare has an interest in being reimbursed for payments they conditionally made in third-party liability cases. Navigating Medicare liens requires an intricate understanding of federal law and the potential consequences of mistakes can be severe, including double damages or referral to the Department of Treasury for collection.

Hospital Liens:

Hospitals provide medical services to injured individuals with the expectation of receiving payment for their services. In cases where individuals lack sufficient insurance coverage or face financial difficulties, hospitals may place liens on personal injury settlements or judgments to recover unpaid medical bills. Proper itemized billing is crucial to verify the accuracy of the charges.  This ensures transparency and fairness in the lien resolution process and ensures that you do not overpay hospital charges.

ERISA Liens:

Employer-sponsored health insurance plans governed by the Employee Retirement Income Security Act (ERISA) may also assert liens in personal injury cases. ERISA liens can be particularly sophisticated and difficult to resolve as they involve federal regulations as well as stringent compliance requirements. Case law has clarified the obligations of plan administrators in asserting ERISA liens, emphasizing the need for active assertion of a lien interest, clear and concise policy language and compliance with documentation requirements. Analyzing funding status and controlling documents is crucial to formulating strategies to gain leverage in negotiations.

Military and VA Liens:

Military personnel and veterans often receive medical treatment from military hospitals and VA medical facilities. When these individuals are involved in personal injury cases, the government may assert liens to recover the costs of medical care provided through military or VA healthcare systems. It’s fundamental to understand the unique jurisdiction and procedures associated with military healthcare facilities. These liens can involve complicated federal regulations. VA liens involve the Department of Veterans Affairs. It’s important to note that the laws governing VA liens can vary depending on the nature of the injury and the specific VA benefits received by the veteran.

FEHBA Liens:

The Federal Employees Health Benefits Act (FEHBA) provides health insurance coverage to federal employees and retirees. If a federal employee or retiree is injured due to the negligence of a third party, FEHBA may cover their medical expenses with the expectation that they be reimbursed from any settlement funds. FEHBA liens are governed by federal law and can be challenging to navigate. Case law that exists provides that these plans preempt state law but do not provide much other guidance.

Disability Liens:

In personal injury cases involving individuals with disability benefits, there are disability liens to consider. When these policyholders receive settlements or judgments in personal injury cases, the disability insurance company may assert liens to recover the disability benefits paid. Disability liens can present difficult legal challenges. You must navigate the terms of disability insurance policies, which can vary widely, and negotiate with insurance companies to reduce the liens and ensure clients are not unfairly burdened with repaying disability benefits that they have already received. The disability plan’s policy language and the nature of the case are important components to analyze.

Private Health Insurance Liens:

Private health insurers, such as Blue Cross Blue Shield, Aetna, or United Healthcare, provide healthcare coverage to individuals through insurance policies. In personal injury cases, these insurers may assert liens to recoup the payments made on behalf of their policyholders for medical treatment related to the injury. Understanding the terms and conditions of private health insurance policies is essential when dealing with these liens. Case law and statutory framework in each state has emphasized the need for insurers to explicitly state their subrogation rights in their policies.

Important Practice Note:  It is essential to assess whether a private insurance plan is really a Medicare Advantage or Medicaid Managed Care Organization (MCO) in hiding. Those plans are not governed by state law and require your swift attention.

Navigating Complex and Evolving Laws

Healthcare lien laws are elaborate yet vague , with federal and state regulations governing different aspects of liens. These laws are subject to change, and staying up to date can be a daunting task for busy personal injury attorneys. Engaging a Lien Resolution Specialist gives trial lawyers access to the latest legal insights regarding lien resolution. Specialists keep abreast of recent case law, regulatory shifts, and evolving lien reduction strategies, enabling you to maximize your client’s recovery while focusing on what you do best.

For instance, in the complex world of Medicare or Medicaid liens, experts can calculate the appropriate proportion of the settlement that should be allocated to the lien, ensuring that clients receive their rightful share of the recovery. In hospital lien cases, experts can scrutinize itemized bills and challenge overinflated charges, leading to substantial lien reductions. Moreover, experts are skilled in identifying potential unrelated treatment or discrepancies or duplications in lien calculations on lien statements, which can result in further reductions. This attention to detail can make a significant difference in the final net amount received by the client.

Healthcare lien resolution requires a deep understanding of the specific strategies and tactics necessary for each type of lien. Lien Resolution Specialists bring this expertise to the table, tailoring their approach to the unique circumstances of each case. Each company that handles healthcare lien recovery efforts operates differently. Having an in-depth understanding of the inner workings of the recovery vendors can provide significant advantages in the  negotiations.

Enhanced Client Satisfaction

When you opt to utilize an expert in lien resolution, you’re not only lightening your workload but enhancing your client satisfaction.  By bringing in experts to handle lien resolution, you are demonstrating a commitment to protecting your clients’ financial interests. This can build trust and confidence, leading to greater client satisfaction. Clients are more likely to recommend attorneys who have successfully reduced their liens and ensured they received a fair portion of the settlement or judgment.

Outsourcing to Synergy is THE ANSWER

To navigate these complexities effectively and prioritize the best interests of your clients, you should engage a team of Lien Resolution experts like Synergy. By understanding the nuances of healthcare liens and the legal principles that govern them, and entrusting the resolution to experts, you are restricting the lienholders to funds only when truly entitled to reimbursement for medical expenses incurred. You are also ensuring that your client is receiving the maximum compensation they deserve. Contact Synergy to learn more.

Brian Breiter and Joseph Limbaugh on TLV Podcast

Hello, Fellow Trial Lawyers!

Announcing a fascinating new episode on Trial Lawyer View with Brian Breiter and Joseph Limbaugh from Improv for Trial! 🌟⚖️Join us as we delve into the world of trial law using the power of improvisational techniques in the courtroom. Discover how Brian’s passion for justice has driven his exceptional career and why he believes in the use of improv skills by trial lawyers. 💼🏛️

Brian and Joseph take you on their incredible journey, sharing insights about their unique partnership and the creation of Improv For Trial. Learn why they advocate for every trial lawyer to undergo this transformative training, and how it can elevate storytelling and connection in legal practice. 🤝📣  Discover Brian’s unique approach of connecting deeply with clients, understanding their stories, and mastering the art of storytelling as a litigator. 🤝📣As Brian reveals the beauty of merging improvisational theater with law, you’ll understand how these techniques can enhance courtroom performances and build authentic connections with juries. 👥🎭  Incorporating these skills, Brian shares compelling stories, including one where a $50k offer blossomed into an $8 million verdict, showcasing that mistakes are valuable gifts in the journey of advocacy. 💰👏

Don’t miss this engaging episode filled with wisdom and practical advice for every trial lawyer! 📚🎭

Thanks for listening!

Jason D. Lazarus, Esq.