Posted On: October 6, 2007, 12:38 am CDT

Posted By: Diana

MG: Thanks so much for your advice, but it doesn't work that way. First of all if you go to ER, they know you have been in an accident. I couldn't just lie, and say, Oh, I don't know what happened to me. Duh! The bill gets SENT to Medicare. Medicare is not like some private ins companies who pay up front and then go after the responsible party. They are the government. The rules are different, believe me. A post office truck ran a red light once years ago, and crashed into me. I received a letter in the mail immediately stating that you couldn't sue the government, they wouldn't pay to fix your car unless you signed a release on the entire claim (injuries & car repair), etc., etc. It was a difficult battle to get my car fixed. You can sue the govt., but there is a lot of red tape to go through. My atty back then told me, the worst auto accident you can ever get involved with is a government employee. This time, though, I called my ins co because I thought that was what PIP was for, to pay my medical bills because I knew Medicare probably wouldn't pay. I, nor my ins co realized at first that PIP was not responsible because it happened out of the state and I was not in my car. I've checked everything out with more than one atty. Also, I've talked to supervisors and every dept Medicare has, dozens of times, & I read it on their web site. MEDICARE WILL NOT PAY for auto related injuries when there is other insurance involved that is responsible. The 3rd party ins is responsible and will not pay till I sign a release. The 3rd party is primary for the accident related bills, not my other medical bills, but Medicare is trying to say the 3rd party is primary on everything. I have to appeal every claim. I didn't want to sign off till I was finished treating for the injuries. Besides, the 3rd party ins didn't even offer me enough to cover the ER bill. Believe me, I AM NOT LOOKING FOR SYMPATHY. I'm just STATING THE FACTS SO PEOPLE CAN SEE HOW SCREWED UP OUR INSURANCE LAWS ARE! No, Ohio is not a no fault state. The 3rd party, (the ins of the party who hit me), is the one responsible, but I haven't signed a release yet letting them off the hook, so until I do, they will pay nothing. PIP was designed partly to keep people from running to lawyers and having litigation. But it worked the opposite here. I didn't want to get a lawyer involved, but since PIP wasn't liable & Medicare & 3rd party wouldn't pay, I had no choice. Medicare paid for awhile, till they finally realized there was an auto accident involved. It just took them awhile to find out. Now, they want everything reimbursed that they paid out & until they are reimbursed, they will pay no more of my claims, accident related or not. They said they paid their conditional amount already. They are allowed to decide what the conditional amount is on each case. They can make it whatever they want. A SHINE rep told me this. My current ins co stated that there is no type of auto ins coverage you can get that will cover pedestrian auto accidents in or out of the state, except PIP would have paid if it had happened IN the state. This is what I'm questioning. I'm not an ins person, so I don't know if this is correct. My current ins co told me that you can get med pay coverage up to $5,000 with them, but it only comes into play if you are in an auto accident and you are IN an auto. It doesn't cover PEDESTRIAN accidents in or out of the state. When you go on Medicare, the rules are different than with private ins companies. I don't want to appear to be complaining. I am trying to get EDUCATED about some of these ins laws. I am just amazed at the predicament a person can get into because of the stupid way some of the laws are set up. Our laws need to be changed. Since PIP was revived as of today, you can have a pedestrian related accident IN THE state and PIP will pay. Do not get in a pedestrian related auto accident OUT of the state if you are on Medicare. Pip won't pay and Medicare won't pay if the party who hit you has ins. Good luck trying to get the 3rd party to pay. I do wish that people would stop telling the thousands of people on Medicare that all they need is Medicare to pay for their auto accident injuries. This is misleading and definitely not true. As long as there is another ins involved that is responsible, MEDICARE WILL NOT PAY.