Q: does a patient have to be self pay for an accident at a store?
my mother fell in a store and broke her kneecap and all the surgeons she has called are saying she has to be self pay and they cannot take her insurance because it was an accident that happened in a store.
A: No, this is not accurate. However, if your mother has Medicare, and if the store has a med-pay policy (most business casualty policies have a $5,000 no-fault medical bill coverage benefit that pays without regard to whether the store is liable or not), then Medicare may decline to cover the treatment until the med-pay policy is exhausted, and this could be the reason the doctors are saying this. If your mother's fall was the result of the store's negligence -- such as a spill, debris, cracked or uneven flooring, etc. -- then she should consult a lawyer ASAP and have the lawyer arrange the medpay coverage to exhaust that before submitting to medicare. If she has other private insurance, then this should not be an issue. the med-pay can be used to reimburse the private health insurer's benefits paid after the fact. The lawyer can assist in this instance. In addition, many orthopedic practices will accept a lawyer's lien letter to allow payment out of settlement proceeds, which would avoid your mother having to pay out-of-pocket for treatment pending settlement as well as negotiating/arranging the health insurance coverages.
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