Insurance Problems with Surgery Coverage...

by Anthony
(Deerfield Beach, FL USA)

My orthopedic surgeon accepted a LOP (Letter of Protection) and performed a surgery for a torn meniscus in my left knee. Well now he does not think the no-fault auto accident caused my injury. I just had an MRI done and they found several dead bones in my left knee. Needless to say I tried to go through Medicare but they are denying it because of my open personal injury case.

My attorney's secretary says she called my doctors office to see if he says my injury is related to the accident so that I can get an LOP. But if he thinks my injury is not associated with my car accident than how will he accept an LOP? Is there any other way I can get Medicare to cover the surgery until the case is resolved? Thanks.

Visitor Question:
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ANSWER for "Insurance Problems with Surgery Coverage...":

Anthony (Deerfield Beach, FL USA):

It is our policy at not to interfere in an attorney-client relationship. To do so would be legally inappropriate. You should ask your attorney about your access to Medicare. We can though give you some general information about Medicare which may be helpful in your situation.

If you are presently receiving Social Security disability assistance or if you are 65 or older you may qualify for Medicare. If you are not disabled nor 65 or older you will need to seek another avenue for your medical needs. If you have an open personal injury case and are presently receiving Medicare assistance, Medicare has an absolute right to recover reimbursement proceeds from your personal injury settlement or proceeds from a personal injury trial award.

If the doctor believes your knee injury is not related to your accident you may not have a very good personal injury claim - or any claim at all. You must speak with your attorney.

If your attorney doesn't believe you have a legitimate chance of prevailing in your personal injury claim and withdraws from your representation (thereby closing the claim) AND you qualify for Medicare, then you may be able to have Medicare pay for your medical needs.

Best of luck,

Law Guy

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