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Clearing Claims: Tips for Medical Pay Reimbursement Claims

By Gabriella Khorasanee, JD on July 22, 2013 | Last updated on March 21, 2019

In our new weekly series, "Clearing Claims," we share with you our tried and tested tips on negotiating various types of liens, as they arise in the context of personal injury cases. Last week, we shared tips on negotiating hospital liens. Now, we give you the inside track to negotiating medical pay lien claims.

First things first, we're going to call these medical pay lien claims what they are -- claims for reimbursement that arise by contract. The use of the term "lien" here would ignore the heart of the issue, subrogation and/or reimbursement.

So now that we have that settled, what's next?

1. Read the Contract

This may seem fairly obvious, but it’s worth mentioning: Read. The. Contract. Your client’s auto insurance contract will be your road map as you embark on the path of medical pay reimbursement claims. Look for the important issues: (1) does the policy have medical pay coverage? (2) does the policy language have a right of reimbursement written into it(3) does the contract language limit the parameters of the reimbursement claim? The answers to these questions will help clear the fog at the outset.

2. Reduce, Reduce, Reduce

Just because the insurer makes a certain claim for medical pay reimbursement doesn’t mean you have to accept it at face value. There are ways that you can reduce the claim including: (1) reducing for actual recovery; (2) reducing the health insurance lien by applying the statutory scheme; (3) reducing for comparative fault; (4) reducing on the common fund doctrine; and (5) reducing based on the make whole rule.

3. Use Common Sense

Common sense is your best friend — always use it. First, it’s important to know which expenses are negotiable, and which are not. For example, ambulance fees are normally non-negotiable so it would be wise to use med pay to pay the ambulance bill first. Second, building a good rapport with a lien claimant is invaluable. It’s easier to let them see that something in hand now, is better than taking a risk and possibly getting nothing down the road.

For more useful tips and detailed information on how you, or your colleagues, can negotiate claims for reimbursement, please read our “Negotiating Tips for ‘Med Pay’ Claims for Reimbursement” practice guide. Remember to share these tips with your colleagues, they may have something helpful for you in return.

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