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  1. #1
    Join Date
    Dec 2013
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    18

    Default Not Seeking Cms Approval for Wcmsa

    My case meets all the requirements for CMS approval. However, both my attorney and the defense attorney want to settle without CMS approval.

    The settlement suggested is a compromise and release which would include a wcmsa. The only difference is that the wcmsa would not be submitted to CMS for review.

    Has anybody settled in this manner?

  2. #2
    Join Date
    Oct 1971
    Posts
    4,913

    Default Re: Not Seeking Cms Approval for Wcmsa

    Quote Quoting peppertree View Post
    My case meets all the requirements for CMS approval. However, both my attorney and the defense attorney want to settle without CMS approval.

    The settlement suggested is a compromise and release which would include a wcmsa. The only difference is that the wcmsa would not be submitted to CMS for review.

    Has anybody settled in this manner?
    Don't do it, Medicare will not cover the cost of future medical - you'll be on the hook for 100% of medical from here out.
    Tell them to do things proper or no deal.

    Tony
    Moderator Responses are based on my personal bias, experience and research - They do not represent the views of the admin nor may be accepted in the legal community, always consult an attorney.

  3. #3
    Join Date
    Dec 2013
    Posts
    18

    Default Re: Not Seeking Cms Approval for Wcmsa

    I was told this was the deal or no deal at all.

    From what I understand they feel the MSA would be higher than my total settlement amount.

    I read somewhere that if the WCMSA is not approved by Medicare that CMS can ask for your entire settlement to be used for the work related injury treatments. As weird as this sounds I would actually be okay with that as long as my treatments were billed at the Medicare rate and then I repaid Medicare back from my settlement.

    Do you know how this would work. Would I be able to receive treatment for the work-related injury parts, and then repay Medicare from my settlement? Or would I be in the situation were the work-related injury parts would be denied from the beginning and then I would be billed as a cash patient/or whatever negotiated price I could manage to work out.

    I could afford to pay at the Medicare rate. There's no way I could pay at the cash patient rate.

  4. #4
    Join Date
    Oct 1971
    Posts
    4,913

    Default Re: Not Seeking Cms Approval for Wcmsa

    they feel the MSA would be higher than my total settlement amount.
    That's irrelevant - the MSA is separate and additional to the money due for wage loss.
    It's a way for the carrier to pay a portion of your future medical, it's got nothing to do with the money due you.

    I read somewhere that if the WCMSA is not approved by Medicare that CMS can ask for your entire settlement to be used for the work related injury treatments.
    They will not pay for future medical until the entire amount of the settlement is exhausted in payment for medical associated with your work related injury.

    I could afford to pay at the Medicare rate. There's no way I could pay at the cash patient rate.
    You won't qualify for the Medicare rate if you're not eligible for Medicare - you're on self pay.
    Here's the rundown on Medicare Set-Aside Arrangements , go through and read up.

    Workers’ Compensation Medicare Set Aside Arrangements
    A Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) is a financial agreement that allocates a portion of a workers’ compensation settlement to pay for future medical services related to the workers’ compensation injury, illness, or disease. These funds must be depleted before Medicare will pay for treatment related to the workers’ compensation injury, illness, or disease.
    All parties in a workers’ compensation case have significant responsibilities under the Medicare Secondary Payer (MSP) laws to protect Medicare’s interests when resolving cases that include future medical expenses. The recommended method to protect Medicare’s interests is a WCMSA.
    https://www.cms.gov/Medicare/Coordin...-Overview.html

    There may be extenuating facts that may be relevant but I will make this general statement based on what you've posted.
    Someone either doesn't know what they're doing or they're trying to screw you - don't do it if you believe you'll still be needing medical care for your work related injury - you'll lose everything.
    Tell them thanks but no thanks - my money says they'll come around and do things the right way when they know you ain't falling for the scam.

    Tony
    Moderator Responses are based on my personal bias, experience and research - They do not represent the views of the admin nor may be accepted in the legal community, always consult an attorney.

  5. #5
    Join Date
    Dec 2013
    Posts
    18

    Default Re: Not Seeking Cms Approval for Wcmsa

    Thanks Tony. I am currently a Medicare recipient.

    From what I understand from the documents that I use the wcmsa funds first. Then I'm confused, if I don't have CMS approval and I have depleted my non-approved WCMSA would I start using Medicare and then they would send me bills for reimbursement until my settlement was gone?

    I know what you're saying it doesn't sound right. I've been at this for over a decade and I just want to get on with my life. My gut tells me not to take the deal. I have a retirement income from my past employer so I'm not so concerned about monthly income. Just trying to understand what exactly a settlement with this language would be looked at from Medicare's eyes.

  6. #6
    Join Date
    Oct 1971
    Posts
    4,913

    Default Re: Not Seeking Cms Approval for Wcmsa

    There are no short cuts, if you fail to set up an MSA, you will be ineligible for Medicare and be on the hook for future medical.
    You better consult another lawyer or a rep from Medicare before you do anything - someone's jacking you around.

    Tony
    Moderator Responses are based on my personal bias, experience and research - They do not represent the views of the admin nor may be accepted in the legal community, always consult an attorney.

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