Do Hospitals Have to Accept Medicare After an Auto Accident in Las Vegas, Nevada?

Having Medicare can save you a lot of money on monthly insurance bills. If you have Medicare, you may think that you can simply show your Medicare and supplemental insurance cards to the hospital after a traumatic car accident, and expect Medicare to pay the bill. However, it would surprise many Medicare recipients to know that the hospitals are not required to bill Medicare after a car accident.


According to federal Medicare law, a hospital has the option to bill Medicare for the treatment you received as a result of a car accident. However, they can choose not to bill Medicare and instead wait for the proceeds of the personal injury settlement to pay your hospital bill. See Medicare Secondary Payer Manual, Chapter 2, section 40:  

40.2 - Billing in MSP Liability Insurance Situations 

A - Difference Between Liability Insurance and Other Primary Plans 

Liability insurance differs from the other insurance policies or plans that, under §1862(b) of the Act, are primary to Medicare. In the case of other types of insurance that are primary to Medicare, i.e., no-fault insurance, group health plans, and workers' compensation, the insurance has a contractual obligation to pay for medical services provided to the covered/injured person. Liability insurance, however, has a contractual obligation to compensate the alleged tortfeasor for any damages the alleged tortfeasor must pay to an injured party. 

B - Billing Options and Requirements - Alternative Billing 

Generally, providers, physicians, and other suppliers must bill liability insurance prior to the expiration of the promptly period rather than bill Medicare. (The filing of an acceptable lien against a beneficiary's liability insurance settlement is considered billing the liability insurance.) Promptly means payment within 120 days after the earlier of: 1) the date the claim is filed with an insurer or a lien is filed against a potential liability settlement; or 2) the date the service was furnished or, in the case of inpatient hospital services, the date of discharge) rather than bill Medicare. Following expiration of the promptly period, or if demonstrated (e.g., a bill/claim that had been submitted but not paid) that liability insurance will not pay during the promptly period, a provider, physician, or other supplier may either:
    •    bill Medicare for payment and withdraw all claims/liens against the liability insurance/beneficiary's liability insurance settlement (liens may be maintained for services not covered by Medicare and for Medicare deductibles and coinsurance); or
    •    maintain all claims/liens against the liability insurance/beneficiary's liability insurance settlement. 
 
The above Medicare manual says that after 120 days of non-payment, a hospital can bill Medicare for your hospital bill. However, that is a choice that a hospital can make. Instead, the hospital can simply wait for your case to settle and get paid through the settlement proceeds. 
 
If you read my prior blog on health insurance, you will know that pursuant to Nevada law, if you have health insurance, the hospital must bill the health insurance first. However, if you have Medicare as your primary ‘health insurance’, this law does not apply. The reason for this, is that Medicare is governed by Federal law and Federal law trumps State law. 

If your hospital chooses not to bill Medicare for your hospital bill, your injury attorney will work with the hospital’s collection agency that tries to collect payment directly from you. Your injury attorney will request that all collections efforts are put on hold until your personal injury case is resolved and payment can be made through your personal injury settlement.

Next time, we will discuss whether health insurance companies can be reimbursed for medical bills they paid after a Las Vegas car accident.