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Home :: FAQ :: Personal Injury

If I become a Plaintiff, and I am a Medicare Beneficiary and sustain injury, who is liable for damages including the amounts that treating physicians charged under contract/letters of protection?

You are liable to your physicians for bills you incur even though the person who caused you injury may be liable to you to compensate you for those damages.  If you assign your claim in writing to your physician, that physician has your claim for the bills you incurred to him on account of someone else’s negligence but this recovery is a limited one.

Pursuant to Florida Statute §465.056 treating physicians are limited to charges authorized by Medicare as found in 42 U.S.C § 1395 et seq., which provides that physicians may charge only a limited amount above the Medicare-Approved Amount when the physician does not accept assignment of the claim.  See 42 U.S.C. § 1395w-4 et seq., 42 C.F.R. §§ 424.56 and 414.48.

Medicare set the limiting charges for years subsequent to 1993 at 115% of the Medicare-Approved amount for unassigned claims.  See 42 C.F.R §414.20 and 42 C.F.R. §414.48 (if the physician accepts assignment of the claim, the physician is limited to only 100 percent of the Medicare-Approved Amount.)

Moreover pursuant to 42 U.S.C.A § 1395w-4 (g) no Medicare Beneficiary is liable for payments of any amounts billed for service in excess of the limiting charge.

Physicians who are enrolled with Medicare are bound by agreements not to charge Medicare Beneficiaries individually for services that the individual could have had covered under Medicare. See 42 U.S.C. §1395cc. So, notify your physician immediately that you are a Medicare recipient so that he is not stuck holding the bag for his services or expecting you to make payments that Medicare would otherwise make.