Posted On: October 7, 2007, 12:57 am CDT

Posted By: Diana

MG: Thank you for your comments and your time. When the government is involved, (Medicare), things get pretty complicated & the laws change. Nothing remains simple & they never do things like the norm. I agree with a lot of what you are saying, but I am confused about some things. I have already talked to supervisors at MSPRCP, Claims & Coordination of Benefits several times. I am a very assertive person when I call them, but yet, they give out very little info and every dept you talk to tells it differently, even the supervisors. They all are unanimous that the ins co of the at fault party is the primary ins co responsible for my claims pertaining to the accident and also the ones not pertaining to the accident. Even the 3rd party agrees they are the responsible party for the accident related bills, but they say they don't have to pay a cent till I'm ready to settle and sign off. They say that is the law. The SHINE rep told me to appeal ALL claims stating that Medicare should make conditional payments on all of them until the time I am reimbursed from the 3rd party ins. I told them this on the phone, but they state they have already made their conditional payments. I already know for a fact that Ohio is not an at fault state. They do not have PIP. But, I don't know how different the Ohio laws are from Fl laws and how much this would affect this situation. I was told that the 3rd party ins co is responsible, but they do not have to pay until I'm ready to sign off, then they would make a one time final payment. When they offered me a sum of money that wouldn't even pay all of the ER bill, I had not even followed up with a doctor because I couldn't find one in Fl initially, who would see me regarding the accident. Therefore, I wasn't ready to sign off. This thing dragged out so long, I wasn't getting the treatment, etc., & things I needed in a timely manner, therefore, I am still not ready to finalize it, but I will be forced to if I want to get my ins (Medicare) benefits back, because I can't get treatment if I'm without medical benefits. I may take your advice aboaut the TV a little later, depending on what transpires in the next few weeks. I am not one for wanting to be in the spotlight. I don't like telling people the predicament I'm in, but yet, I think people should know what is going on with our ins laws, so they won't also end up in the same situation. I told my situation here in order to try to get some education or feedback on the subject from anyone who might have knowledge on the subject. I think our legislature should know that the laws need revised for a lot of reasons. Our ins laws don't work in many instances. The SHINE rep I talked to advised me to write to my Senator. I am sending a letter to him Mon. & also appealing all of my claims this week. Thanks, everyone for all of the advice.