Do the insurance companies really know what they’re doing?

by keith on 23/01/12 at 11:33 am

We would like to think that insurance companies are rational, thinking companies. But often, they aren’t. One of the insurance companies latest fears (and thus one of the reasons they use to delay payment) is the potential that Medicare may have to be reimbursed.

My partner recently received a form from an insurance company. Despite the fact that our client hadn’t had any of her bills paid by Medicare and wasn’t eligible for medicare until after her treatment for the accident was finished, the insurance company was worried. They wanted to make sure that Medicare wasn’t going to come back later asking for money, so they authored a “Claims Settlement Allocation Agreement.” The strange part is the way it was written… The agreement is because “The parties recognize and agree that there may be Medicare interests that need to be considered and protected…” They go on to “agree” that “$0″ of the settlement “shall be allocated to release all liability for future Medicare covered medical expenses.”

Where it gets weird is in Paragraph 12. “Should Medicare make a claim for conditional payments, Claimant shall not use any of the CSA funds to pay for said conditional payments.” OK, so the agreement says that we’re establishing a fund of $0 for the possibility that Medicare may make a claim in the future, but if Medicare makes a claim, you are not to use these funds to pay Medicare?!?!

Fear seems to drive insurance companies, at least when it comes to the possibility of parting them from their precious stash of money.

39 Responses to “Do the insurance companies really know what they’re doing?”

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