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Kentucky medicare setaside pending
#1
hello,it has been a few weeks since i have posted but now i am back with more questions and seeking advice and opinions.As I mentioned before,I have a 17 year old wc case.Last month I went to a med fee dispute hearing which was canceled because the ic att. was not even aware I had 2nd surgery 5 weeks prior the ic had paid for.Anyway,the next day the ic was calling me to set up a med setaside.I have done most of the leg work to get to the point of going back to see judge.I have now contacted an att. who wants to take my case and help me.He first asked asked me how much my med bills were each month and then said said that this should be a sizable amount.I am now 40 years old.How many years do ic figure into their estimates?Do I have to take the setaside?Can the money in setaside be used for dental app and such as that?Can anyone give any info on how the setasides work once they are set up?Thanks for everything!
 
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#2
My lawyer was just talking to me about this. I will say, that I am in Va and do not know if your state is the same, but this may give you an idea to some of your questions.

I was told that if you have Medicare, you are required to have the money for medical expenses, set aside. She also told me that the Medicare officeses are bogged down and it does take longer than just setting up a settlement.

Evidentlly, once she requests that the process begin, a guestimation of how much medical expenses I will have for my life. I am 45, so there is a lot of life a head of me, but she said they will take that into consideration. This amount goes to Medicare, who will do the paper work and set up the account. The money will go into a special bank account and every time that I take money out of it, I have to send in my Drs. bill that I used it on. It is only for medical expenses that have to do with your initial injury. So, a dentist bill would not be eligible, unless your injury was to you mouth, jaw etc.

I asked what happens if there is not enough money set aside or if I die and there is extra money in the account. I was told that once the account is empty, then Medicare will begin to pay for my medical. As long as there is money in the account, they won't ever pay for any medical issues, due to the injury. If, on the other hand, I die and there is still money left in the account, the money is mine and will go into my estate.

I hope this helps and I am very glad you got a lawyer. There is specific language that needs to go into any settlement paper work, if you have Soc. Sec. and if you have Medicare. Like you said, there has to be wording about the Medicare set aside, but it also has to have specific language, so that Soc. Sec. won't take any part of your settlement. Without the special wording, anytime you get a 3rd party settlement, Soc. Sec. is entitled to get a good part of it, so make sure your lawyer knows what he needs to do. (I am sure he does, which is why it is good you found someone.)

Good luck.
 
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#3
Ifoster21 Thank you so much for the info,you told me alot i did not know yet.I will meet with my att. next week for the first time.I will be sure to ask him about the special wording.When this first started with the ic my case worker had some woman call me and try to talk me into taking this.this woman told me that the money could be spent on things that I needed and even bills.I told her I did not see how it was legal for medicare to pick up these bills they were responsible for and that I would not accept anything like this unless a judge confirmed this.I later called my case worker and told her of the conversation.She of course said that none of that is true and she had no idea why she would say that.I quess this is just a tactic that some people could fall for.Is there a special account set up in my name somewhere or do the docs and pharmacies bill medicare and they sort it out?Does the att. need to set this up to go to my estate if any left when I die?
 
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#4
Life expectancy is either based on actuail tables or a damaged life medical evaluation.
you can find out more about the set aside requirement here
http://www.cms.hhs.gov/WorkersCompAgencyServices/
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#5
1171- Thank you so much for the links. I will be reading through them, little by little.

Shady-I have asked these same questions, in previous posts, so here is an answer that I received from that older post.

"IF you receive a lump sum settlement from WC, or any other sources for that matter, SSDI will take an offset IF you don't have the "Utica Mohawk" or "Hartman Language" written into the WC lump sum settlement.

IF you are going to be eligible for Medicare within 30 months, then you need a 'Medicare Set Aside also':

Federal guidelines clearly specify that Medicare's interests must always be considered (regardless of the amount of the settlement) before settling a worker’s compensation or personal injury claim if the claimant is a Medicare beneficiary."

My understanding is that the set-aside acct. is in your name and you can take from it, as you have a medical need. But somehow Medicare has access to it and they will look over the whole process, of matching your receipts to the amount in the acct.

I would guess that there is special language, about keeping any left over money to your estate, but that is just a guess on my part. If you find the answer, in the links that 1171 posted, please let me know. It will take me a while to sit at the computer and read the different links, but I am going to start and just go slowlyWink.
 
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#6
Shady...Thanks for this post, it is very informative & I have saved it to my email.
What scares me is, i asked my attorney what happens to my setaside money if i never use it up (die or whatever)...and he says it's just gone!!! Well, now i guess I better be speaking to him about this...i did not know the remainder would go to my/our estate! NOW I'm nervous about my lawyer!!!

Take care everyone, Lilly
Injured worker, & tired of it all! I'm too old for games!!

A careless word may kindle strife, a cruel word may wreck a life, a timely word may level stress, and a loving word may heal and bless!
 
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#7
Thanks to all for the links and info.As I mentioned earlier,i have an app. with my new att. on the 13th and I have written down some questions and wordings {Utica Mohawk and Hartman Language} to ask him all about.I do already have 100% disability and am praying that this setaside does not affect it.I will post all info that I recieve for you all on Thursday evening,late.I was reading through some of the links that 1171 had provided and found a memo that wc had sent out in May stating that from now on they would only be using the Center for Disease Control{CDC] statistics to evauate life expectancy.I then went to CDC to check out my age group.If you dig enough you can find out quite a bit.Like I said,I have most of the leg work already done for my att..I will keep you posted on all I find.LOL
 
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#8
then you may not need one are their ombudsmen for your state?
........I love cats, I just cant eat a whole one by myself......







 
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#9
I think that is what we call specialists in Ky.,at least that is all i have ever heard them called.I have not signed anything with att. yet.I am just hoping he may be able to get more than I can.You see,once they saw I did not have an att.,they went to moving things along really fast.
 
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#10
Lilly, it would be good to look into the info. re. extra money in the set aside account, but it is possible that it is a state rule. Now that I read your post, I am hoping that my lawyer knew what she was talking about, when she told me that it would go into my estate.

Good luck.
 
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