and the real issue in this case is whether or not a health care provider such as ours have has the choice whether or not just in many creationists medical expenses or their expenses for a patient to that person's medicare or any other health insurance or if they have the option to instead file a need under the health care services in the now in this particular piece o s f chose not to submit her insurance you cannot submit bills directly and my position is that medicare although it is a government entity that is the same that there are a guarantor of the medical expenses but i view them as the same as an insurance company and as soon as we cross the shield in medicare recipient does pay a premium every month to maintain medicare benefits so similar to a blue cross we should really have to make your monthly payment you do as well with medicare blue cross blue shield and any other insurance company you can submit the bills directly for payment in this particular case because it's medicare you cannot submit the village yourself those only can come from a medical provider there is  right that i did contact medicare to have these bills paid i received correspondence from medicare which is contained in the record where after contacting o s after i was at informed them that another insurance company was primary referring to the defendant's insurance company negligent drivers insurance company progressive as primary so based upon that medicare then said well we're not primary or secondary position is that the defense insurance company negligent drivers insurance company will not be primary and this is no facts and medical payment coverage under her own automobile policy would be primary but she only had a five thousand dollars limit which was insured injured to pay any of her medical expenses and till and at what point there would be a trial and a judgment if they entered into settlement negotiations prior to filing suit and of a trial and verdict that's one thing but they have absolutely no obligation to pay any of her medical expenses part of settlement or verdict and unless that takes a position that because this is nowak had medicare they asked medicare isn't as a secondary paid or twenty five to one week five three deals with medicare as a secondary pain or and what it says is that someone else out there is primary another health insurance company perhaps she had room to cross the shield policy or something  through work that would be primary or med pay on her auto would be primary and in certain circumstances the long in the liability carrier in this case would be progressive as primary but they say though is why and it's a situation where the after all liability carrier so in this particular case probably when the beneficiary would be mrs no dad makes a claim and they refused to pay defendant negligent parties insurance company pays medical expenses prior to any final settlement they just give you one lump sum settlement at the end they don't pay any medical expenses so in this particular case i'll accept takes the decision that medicare is a secondary pay or so they don't even have to submit the bell might position is whether or not medicare would have paid the bill or not is not the issue the issue is their absolute denial and refusal to submit the bill a requests and this is no that's repeated requests for the man medicare in this particular case paid every other medical expense that she had related to this motor vehicle accident knowing they act progressive is not going to make payment on days then they will make payment on the medical expenses but in this particular case medicare could never even make that determination because o s f refused to submit the bills to them to them for payment as a result they held their lead now and recover hundred thousand dollars one hundred eighty seven thousand dollars bill as opposed to what medicare would have pain which would have been considerably less like i said all her other medical expenses were paid by magic here which she did pay back out of the settlement proceeds  in this particular case as a result of o s f refusing to submit the bill for pain that this is no bad mrs novak was deprived of the benefit of her premiums to medicare and her benefits from medicare  there is no specific case dealing with the help here services lead act with whether or not a provider must submit to insurance but as i said in my query i don't think that the legislature would have anticipated that a provider would not want to get paid immediately from a health care insurance or other you're unsure of the medical expenses and would rather leave their lien out for years and then recover later than that something that you can consider when you negotiate in that they have their lien out there you know in this particular case the settlement amount was the policy limits there was only a set amount of money and it was three hundred thousand dollars  because of the limited amount of insurance available from the at fault driver the three hundred thousand when handling a personal injury claim it's important to have the medical expenses paid by some collateral  source because often times next the only way that the injured party is going to be benefited and actually receive money otherwise everything will go to the attorney and medical expenses and that's the purpose of the collateral source rule in this particular case was in this accident is three hundred thousand dollars worth of insurance without having some other collateral source pay her medical expenses like medicare had paid the other medical expenses and we had all and there is no peace on point because the statute does not state specifically that the provider must submit it to health insurance but it doesn't say that they don't have the intent and for the a so that providers would provide care and treatment to who are not paying patients and our position is that if someone has health insurance it's they are not eight or nine t patient they are just a patient with insurance the purpose of the lean and the so people who can't just go to any provider give them their insurance or and get treatment can go to these providers and say i don't have insurance i have a personal injury settlement would you treat me   medicare recipient i have spoken out collect on the balance of the bill but that's sort of twisting the statute too because you're saying medicare will pay the bill but now we can't see the extra eighty seven thousand dollars was medicare but let this situation is that they just didn't read enough to see the remainder of the bill but in by law they can and often times medical providers do and in this particular situation have a lady who had met here who would have paid the entire bill other than what she would have been responsible for contractual not which would have been a minimal amount and instead shipyard thousand dollars out of her settlement was she could potentially be liable for another eighty seven thousand dollars when she had valid insurance another scenario which is absolutely relevant to this case is a situation where if there had not been a settlement with mrs novak's with between mrs novak and progressive and there was a trial and perhaps the jury found the other driver not guilty and there is a zero verdict and zero recovery i want to slap has now refused to submit the bill to medicare which you only have eighteen months to submit a bill for peanut to medicare so if you're reading the litigation process and several years down the road oh yes that still has one hundred eighty seven thousand dollars bill outstanding which would have been paid by medicare they refused to submit it and now my client would be responsible for the hundred seven thousand dollars and that's it and that that's a very real possibility any time you take a case to trial in this particular case oh my sat is not saying it is our policy never  admit a bill to medicare for pain what they're saying is in this particular case we chose not to and as i stated in my brief the reason as had to submit it to medicare they probably would have received maybe twenty or thirty thousand dollars on the bill but moving the lean out and the bill unpaid they received one hundred thousand dollars from the settlement and it is a situation where all i said is looking to insurance policies and limits the asphalt drivers to determine whether or not they're going to submit their bills to medicare or not and unlike the rest to shield where if my client has had numerous the shield she went to was that she could receive the bill and submit it herself in this particular case the only person that would have submitted the bill was o s f and they refused not to so as a result she had a plan additional seventy eighty thousand dollars on the bill and they received an extra seventy or eighty thousand dollars on  that's a reason she's paid the premiums is for that contractual adjustment that she was entitled to have medicare paid as a result of o s s refusal to submit its medicare she was deprived of that contractual just in it which is her benefit which is why  e the collateral source rule because the supreme court has held that if there is a benefit or in windfall it should go to the injured party and that case they're dealing with whether or not the defendant should be responsible for the entire amount or reasonable charges but in this particular case it's the same theory that oh yes alan did benefit from this is no back being a patient as a result of the motor vehicle accident as opposed to her being a patient who just fell decision to maximize the compensation they receive from the insurance company is something the country would see if you can relieve the burden on medicare no it absolutely is against public policy because if it is a situation where the defendant driver has twenty thousand dollars worth of insurance and it all as happened in the last name or they would get six thousand six hundred sixty six dollars and that situation l s s would have submitted the bill to medicare and received twenty or thirty thousand dollars instead our argument is that it's against public policy to pick and choose when you're going to cynical patients bills to medicare depending on your health insurance has nothing to do with previews he had nothing to do with supplemental health insurance counsel even in an open court trial and that she has never seen a supplemental health insurance policy on this case and yet she continues to argue that i need to make that very clear because you should immune misunderstanding on this this case is fairly simple is first track still in there was a medicare eligible person who was injured  health insurance coverage or supplemental policy and it's a little anybody quite frankly that we always have to respond to this and there's no evidence in the court file at all that that also contrary to what counsel argue the medicare if i may the relevant part of it is that no payment under this subsection shall not be made to the extent that payment have been made with you there's no room to be expected to be made under an automobile or liability insurance policy or p a private insurance those private insurance policy should be hanging on this and they even if the regulations say if the law allows you to recover more and i mean what you would recover in medicare you're allowed keep that under law it is not a violation of medicare rules and regulations st francis exhausted their other insurance operated insurance and a third party liability coverage i judge word was exactly right in following federal law he followed the law on the federal the sieges matter where there are multiple universe form you certainly medicare issues one were as prevalent then as they are today a letter from myself to mr gregory a whole thing gregory stating that i would pay them ten thousand dollars or somewhere there abouts which is probably the equivalent of what medicare would have paid on the bill but nothing more than that so this in retaliation it's as a result of o s s refusal to submit the bill to medicare and the question i know is that does not answer is why didn't they why when she had valid medicare they could have submitted it the bill would have been paid by medicare as all her other medical expenses were but the question is why didn't they when the answer is they didn't because they ended up getting an extra eighty thousand dollars because they refused to do  a thousand dollar benefit of her premiums they got the benefit of her premiums and that's that's a real question as to why they didn't submit the bill he used the medicare secondary paler as a shield as progressive for pm and they never received a denial their position is we're not submitting it to medicare and the reason was they would recover more on their leave than they would have medicare pays the bill they make the argument referring to the merely miller  case saving that under the lean act they could not pursue my client for the eighty seven thousand dollars meaning i don't believe that's correct i don't believe that's a correct statement under the medicare regulations the medical regulations with regard to them pursuing anything in addition is after medicare makes eighteen as with any insurance if the insurance provider or the internet or makes payment the provider of the health provider cannot then go and balance bill for those contraction adjustments that's what the medicare seven year period says is once we've paid the bill your provider own will are that only entitle for your leave to those go after them for any i'm out remaining on the lead and that's natural and not only this situation but any situation where you have a health insurance company willing to pay a bill and a provider refusing to submit they could in the case of the wealthy individual refuse not to submit the bill for payment for instance if someone was involved in her vehicle accident and they knew that person to be a wealthy individual they would just not submit the bill to any insurance pursue only recover on to the medicare apt and medicare is a secondary pain or it's not a situation where medicare would not pay the bill the situation where they refused to submit the bill to medic here because they didn't want to take in less on their bill for the contractual i just meant and as a result they reaped the windfall on their position that the lenient allows them to do that i don't believe is a valid argument only it doesn't state whether they can or cannot it goes to statutory interpretation the purpose of the lien act was to right here in treatment of people who cannot pay i e people who don't have insurance or independent resources to pay the medical even a ham to differentiate any of those cases even bring up the federal act in disgust that in this particular case instead your rules and regulations in a not for profit hospital who is am he in medicare eligible as is the provider to easily lose their license if they were to balance the bill or if