Posted in Medicare
Many people in the Medicare program may find themselves lost in a maze of paperwork and unanswered questions. On occasion we post helpful information from Medicare’s website. The Medicare website provides a wealth of information to those that need help understanding the many facets of how Medicare works. Below you will find information about how Medicare works with other insurances. Recently we shared information from the Medicare website that explained the difference between primary and secondary payer. The following information is also from the Medicare website and explains what conditional payments are. We hope you find this information beneficial. To find more useful tools from Medicare, click here to visit their site.
What’s a conditional payment?
A conditional payment is a payment Medicare makes for services another payer may be responsible for. Medicare makes this conditional payment so you won’t have to use your own money to pay the bill. The payment is “conditional” because it must be repaid to Medicare when a settlement, judgment, award, or other payment is made.
If Medicare makes a conditional payment for an item or service, and you get a settlement, judgment, award, or other payment for that item or service from an insurance company later, the conditional payment must be repaid to Medicare. You’re responsible for making sure Medicare gets repaid for the conditional payment.
How Medicare recovers conditional payments
If Medicare makes a conditional payment, you or your representative should call the Medicare Coordination of Benefits Contractor (COBC).
The COBC will notify the recovery contractor to work on your case. The recovery contractor is a separate contractor who uses the information you or your representative gives to the COBC to see Medicare gets repaid for the conditional payments.
The recovery contractor will gather information about any conditional payments Medicare made related to your pending settlement, judgment, or award. Once a settlement, judgment, or award is final, you or your representative should call the recovery contractor. The recovery contractor will get the final repayment amount (if any) on your case and issue a letter requesting repayment.