I'm sorry to hear about your injury. The answer to this kind of question will vary from state to state. I recommend you seek the counsel of an attorney licensed in California to help you with this process. As you stated, if you utilize medicaid to pay for accident related medical treatment and you recover a settlement that includes damages for past medical expenses (which most do), then you must reimburse medicaid. While the whole process is a little annoying, it makes sense and is pretty fair. That said, you have the right to chose your own medical providers and treatment. Having medicaid doesn't mean you must use it. Often the best medical providers do not accept medicaid. In the context of treating a traumatic injury, your choice of medical providers is very important. Let's face it, no one wants a bargain basement Neurosurgeon operating on or around their spinal cord. Generally, you can choose to proceed with treatment with the medical provider of your choice on a lien basis. Just make sure (1) The medical provider is willing to perform the services on a lien basis; (2) Your attorney approves of the medical provider and the terms of the lien; and (3) The medical provider is charging a fair amount for its services. Good luck.
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Generally you do not have to use medicare but usually it will work to your advantage to do so. The following is an example. if you do a straight lien with a medical provider you will likely have to pay back 100% of the charges. If you use medicare they may pay $20 on a $100 bill. You will get the benefit of the $100 bill in your case but will only have a $20 reimbursement obligation. Medicare is getting much better at being efficient in the subrogation process. Finally if you use medicare or not the insurance company will likely demand to have a letter from medicare stating nothing is owed so in that sense you will still need to deal with medicare. My thoughts are go ahead and use medicare.
Medicaid/Medicare have an automatic right to subrogation. You are right, the other option would be to not bill it through medicare/medicaid and sign a lien. Your attorney could negotiate with the provider for reduction and payment of the lien at the time of settlement. This will be much faster than that subrogation process through Medicare/Medicaid.
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