Presentation liens (2).pptx

Health Insurance Liens Medical Billing Negotiations What is a health insurance lien When a person is injured in a personal injury case and they use their health insurance for treatment, the health insurer may make a claim for reimbursement from the client’s settlement Also known as a claim for subro...

Health Insurance Liens Medical Billing Negotiations What is a health insurance lien When a person is injured in a personal injury case and they use their health insurance for treatment, the health insurer may make a claim for reimbursement from the client’s settlement Also known as a claim for subrogation or reimbursement Only Recover Payments for medical care related to the accident Types of health insurance liens Government Liens Department of Health Care Services (DHCS) also called Medi-cal in California or Medicaid Medicare: People who are 65 or older, certain younger people with disabilities, people with end-stage renal disease Veteran’s Health Administration Medi-cal (Department of Health Care Services) We open the lien through the DHCS website: https://www.dhcs.ca.gov/services/P ages/TPLRD_PI_OnlineForms.aspx We need: CIN number always starts with 9 and ends with letter If we don’t have a copy of the card or CIN number we can request that in the DHCS website using the SSN DOB, DOL, injuries, meds, auto insurance We will receive on the mail a notice of lien Provide settlement info. and or final date of treatment using the health insurance In order to obtain the final lien we need to provide this info. and signed release forms We will receive this second letter It might take up to 120 days from the date of settlement of final date of treatment to obtain the final lien letter with the lien amount Medicare We open the lien via phone or Medicare portal We need: Medicare number or SSN DOB, DOL, injuries, meds, auto insurance, address of the client Send letter of rep. and HIPAA We will receive on the mail a notice of lien and our client too after 30 days from the day we open the lien We will receive another letter called conditional payment letter with an itemization of the benefits received and amount Once we provide the settlement info. we will receive a new letter called demand letter with the final lien amount and reduction We need to contact the correct subrogation company that represent the health insurance plan Other health insurance liens Copy of the HI card back and front DOB, DOL, injuries, meds, auto insurance, facts of the accident Kaiser Permanente Anthem Blue Cross Blue Shield of California Examples of health insurance companies Blue Cross of California United Healthcare CIGNA Aetna Healthnet The Phia Group Important information: Settlement checks cannot have the name of DHCS, Medicare or any other lien holder company If adjusters want to include the lien in the check, ask for separate checks