Legal Aspects of Health Care

¶ … liability insurance issues in the light of End-Stage Renal Disease patients. It has 3 sources.

There are some patients who besides having Medicare have insurance that must be paid before Medicare pays its share of the bill. This applies to all pateints no matter what types of benefits are obtained from Medicare. In cases where no-fault insurance or liability insurance is available Medicare becomes a secondary payer.

Liability Insurance

Liability insurance is "an insurance, which protects against claims based on negligence, inappropriate action or inaction, which results in injury or someone, or damage to property" [No-fault and Liability Insurance, 2003].

If someone has End-Stage Renal Disease (ESRD) than group health plan pays hospital bills first whether or not the patient is enrolled in Medicare. This health plan pays irrespective of whether the patient is a family member or currently employed. If an ESRD patient chooses liability insurance it should be the primary payer. But if the insurance company does not pay the claim within 120 days, the doctors may bill Medicare [Texas Dept of Insurance, 1999]. Thus one must consider that Medicare is a secondary payer if one has ESRD and are covered under one's own plan or any other plan including liability insurance. In cases where liability insurance does not pay, Medicare will only pay for Medicare-covered services. The rest has to be paid by the patient, further there are many other factors that must be considered before choosing liability insurance. If a patient is under 65 and entitled to Medicare because of ESRD and has more than 30 months of Medicare entitlement, Medicare becomes the primary payer [Position Papers, 2000].

Conclusion: