Synergy’s blog brings you the industry’s foremost thought leadership InSights on matters of healthcare lien resolution and Medicare Secondary Payer Compliance. Visit often to discover helpful InSights on important lien resolution compliance issues.
The Federal Employees Health Benefits Act (FEHBA) of 1959 (5 U.S.C. 8901 et seq.) is the largest employer-sponsored group health insurance program in the world, covering more than 8 million federal employees, retirees, former employees, and family members. FEHBA Plans are contracts between the insurance carrier and the United States Office of Personnel Management (OPM).
Synergy successfully employed the Medicare appeals process and obtains a 100% reduction of Medicare’s Final Demand. After submitting consecutive appeals Synergy was successful in having MSPRC agree to reduce the demand amount to zero ($0.00) and issue a refund in the amount of $16,019.73.
Recently there has been some confusion caused by the Florida Bar introducing subsection (E) to Rule 4-1.5(f)(4) and its application to non-lawyer lien resolution companies. Subsection (E) was approved by the FL Bar Board of Governors at their meeting on May 31st and the rule now awaits adoption by the Florida Supreme Court. The confusion, though not unexpected, is clearly resolved by a plain reading of the comment to this proposed amendment.
This case involved a Virginia plaintiff who was injured when a shower chair collapsed. The plaintiff had a pre-existing hip injury which involved an implanted prosthetic. Plaintiff’s counsel engaged Synergy Lien Resolution Service to assist in the resolution of the ERISA plan’s reimbursement claim. Despite the unfavorable law in the 4th Circuit, which was recently bolstered by U.S. Airways v.McCutchen, within two (2) weeks Synergy was able to obtain a 70.2% reduction for a savings of $85,955.02.
This case involved an elderly plaintiff who had Medicare Part C coverage
through his AARP Medicare Advantage plan. Synergy applied its proven tactics and within forty five (45) days had reduced the claim to $2,690.40. This is a reduction of almost 95% which created a savings of $48,978.94 allowing the injured plaintiff to retain over 80% of his net recovery.
Employing experience and expertise, Synergy was able to obtain a
complete waiver and file closure letter from Medicare within 90 days of
beginning work. After waiting a decade from the end of the original
litigation ,the heir is now able to finally put this matter to rest and is able
to enjoy an additional amount of settlement proceeds previously thought lost to Medicare.
On April 16, 2013, the United States Supreme Court clarified how equitable principles interact with the plan language of self-funded ERISA health plans. The question presented to the Court was: Should the principles of “common fund,” often referred to as a reduction for attorney fees, and “made whole,” the principle requiring full compensation to the injured party before subrogating parties are allowed to recover, overcome express plan language abrogating those principles? Sadly, the Court has ruled that they should not.
Families and individuals injured by Vioxx may still have lien claims to resolve despite the Lien Resolution Administrator’s attempt to manage these claims. In a December 4, 2012 ruling the United States District Court, E.D. Louisiana denied the motion of approximately forty six (46) insurance companies to have their lien claims resolved from the Vioxx settlement fund.
Learn more about the Medicare recovery process under the MSP.