Medicare Set Aside

[maw19531]

Can I get any information from CMS regarding my medicare set aside fund. I just settled my work comp case a little over a week ago and the IC is drawing up the contracts now. The IC told my attorney that they submitted the Medicare Set aside for approval already. I asked my lawyer to find out how much money they put in for my drugs and the medical part and he told me not to worry the IC told him that no matter what figure CMS tells them they will fund the set aside. Dont' you think I have a right to know how much the IC has put in for my drug portion. I know my lawyer gets nothing out of the set aside maybe that's why he is not so concerned but my drugs and my monthly visit to the pain management doctor cost around $2000.00. I told my lawyer that before I sign any contracts it is extremely important for me to know what those figures are. Can I call CMS myself or will they not give me any information? I know if the drug money runs out that medicare will have to pay for my drugs but then I will have to pay the co-pays and a lot more since my drugs run around 18,000. There is some kind of limit you have to pay with a medicare advantage drug plan when your drugs run over 2500.00 per year.

[1171]

Yes you can contact them directly.
You can withhold approval or signing the settlement until you get a complete copy of the agreement.

[maw19531]

I called CMS and was told that there is no medicare set aside in my file at all not even a file pending. They gave me a number to call where the set asides are initially submitted. That person told me the same thing. She also told me that I don't even have an incident report on file which has to be done long before the medicare set aside fund is set up. About a year ago the IC hired an attorney that only works on medicare set asides and he sent me an authorization form from CMS to sign for him to get the necessary information needed. Now that was a year ago. I let my attorney know this afternoon once I found this out. I am definitely not signing off on any work comp settlement papers until I know what is going on with my medicare set aside. Something is fishy!!!! Why would the IC tell my attorney 2 weeks ago that the set aside was submitted and is in the process waiting for approval and medicare told me No Way was there a submission in my file.

[Bad Boy Bad Boy]

http://www.capehart.com/CM/Articles/ar-0803.asp

[1171]

Communication is a major problem in large organizations like insurance carriers and governmet agencies. It can be easier if you can get individual names and file or case numbers.

[Bad Boy Bad Boy]

Sounds like (beware the Sneaky Snake) here.

I would caution myself, not to sign any settlement till the Medicare-Set-Aside has been completed and final first. I to, would be advising my Attorney of the same request.

[maw19531]

From what I read today on the CMS site is that the Insurance Co. can close out the Indemnity portion of the case and settle that part but if the medicare set aside has not yet been approved they must leave the medical portion of the case open until the set aside is approved. I sent my lawyer a copy of that and told him it must be in the contract that the medical portion of my case must be left open until the set aside is taken care of. My attorney said I am really the first case involving a medicare set aside for him so he is learning as we go along. I know I am not signing any forms until I know that I am protected. I don't trust no one.

[capricorn]

Maw>>>> That's how things have worked with my husband's case. He settled his lost wage end 2 years ago with open medical for life. Now the IC wants to settle his medical. CMS has done what they have had to do but nothing is completed yet. The IC is still paying all medical.


CAP

[Bad Boy Bad Boy]

MaW is in Illinois, and open medical is so rare in this State you can count them cases on your fingers.

As quoted;
(My attorney said I am really the first case involving a medicare set aside for him so he is learning as we go along.)

I offer one of my best opinions now. I would be asking the Attorney of yours to now bring in another Attorney then to help them with your medicare Set Aside. If your Attorney never done this before you can suffer.

[maw19531]

I just heard back from my attorney. He talked to the insurance company and they are going to settle my case with open medical. The IC told my attorney they never submit the set aside until they know the client is all finished with his medical needs and since just a month ago I was suppose to be evaluated for a spinal stimulator in Wisconsin but decided against it they did not want to submit my file until they knew I was not going to need any further medical treatment. The IC said they will keep the medical open until the medicare set aside is up and running. They will continue to pay for my drugs and monthy visit to the PM doctor. She said the settlement contracts are almost ready for my attorney to look over.