About LASHUNDA Expertise Billing,Claims, and resolutions to the following insurance agencies: Medicare, Medicaid, Coordination of Benefits, Most Managed Care such as HMO's, PPO's, Medicare Advantage Plans, Governmental Agencies such as Work Comp and Veteran's Administration. I would like questions that are in regards to Billing and Collections from Insurance Companies. I can also accept some questions regarding accounts sent to Medical Collections. Please be advised that I reside in Texas and most of my knowledge is based on how it works in Texas.
Experience I have worked in the Medical field for 15 years. I currently help to coordinate contracts for a physician group in Texas. I am extremely good with resolving issues with commerical insurance companies. I'm an expert in coordination of benefits between Medicare and Commercial insurance companies.
My grandmother fell at my mom's home several months ago (she doesn't live
there). As a result of the fall, her Dr. ordered a CAT Scan. The hospital is
now saying that Medicare will not pay for the CAT Scan since she was at my
mother's residence. They are saying that my mother needs to turn the claim
into her home owners insurance. Is this right? If my grandmother has
medical coverage for herself, why would it matter where she fell? Thanks.
Answer Hi Kellie. Thanks for the question. Medicare will not take responsibility for a claim in what's called a "no fault" accident. The claims must be filed to any other insurance available in these cases. The fall is not considered a "medical" condition. It is considered a "slip and fall". HomeOwners insurance will cover it.
It does matter where she fell. If she had fallen in the grocery store, the grocery store would have to require their insurance to pay for any medical treatment she receives. The same is with a family members house. The same rights are granted in either place...a family members house or a grocery store.
Medicare could possibly make a conditional payment but would expect the homeowners policy to repay them.
