Insurers that meet workers' compensation claims for older workers enrolled in certain Medicare plans will see fewer surprises as a new law gives them a clearer picture of the costs they may need to reimburse, experts say.
By law, compensation insurers must reimburse Medicare for all expenses covered by the federal health program that should have been part of an injured worker's claim. Prior to the law on providing accurate information directly, which President Donald Trump signed into law on December 11, compass insurers had to rely on tortfeasors themselves to reveal whether they were enrolled in federal plans.
As a result, health insurers were providing Medicare Advantage or prescription Part D coverage filed compensation after the claims were closed ̵
The problem led to lawsuits, according to experts who say the new law – called the PAID Act – simplifies the process, as the Centers for Medicare and Medicaid Services must submit information on reporting to insurance companies and liability insurance companies.
"This is a big profit for insurance companies," said Shawn Deane, Burlington, Massachusetts Attorney General for Ametros Financial Corp. “There were lawsuits from nowhere against insurance companies and they had no real ability to even determine if a plaintiff had these benefits. This allows them to prepare these coverage issues before a lien or a trial months or even years after that.
Dan Anders, Chicago-based compliance officer for Tower MSA Partners LLC, which works with insurance companies at Medicare Secondary. problems with payer compliance, mentioned privacy laws that previously prevented Medicare from sharing the information with insurers.
When preparing to settle a compensation "everyone thinks we are hunky-dory, and they go and solve the case and a few months later (Medicare) Fördel comes in and sends in a compensation claim, says Anders Anders, who applauded The change. "This gives (insurers) better information that there will be no surprises when the case is decided. … They can investigate any claims and make sure it is resolved, so there are no problems months, years along the way."
Deborah Watkins, CEO of Sarasota, Florida-based Care Bridge International Inc., an insurtech company that helps insurers calculate Medicare compliance costs, says, "In the current [Medicare] portals, there has been no way to "Find out what money is owed without involving the applicant or the lawyer or getting people to ask for information, and it takes months," she said.
The PAID Act gives Medicare one year to update its information technology portals.
Whether the change will save insurers' money is unclear – PAID Act supporters have long argued that the change would save federal Medicare money.
Insurers are likely to avoid litigation costs and costs associated with resuming claims, but that means companies may have to pay more in advance to close damages, Anders said.
"If anything, they can stop paying more money because now they will get a better idea of the Medicare plans out there, he said.