There are no Florida cases say that Medicaid beneficiaries must treat with doctors who accept Medicaid.This assumes that someone’s negligence caused the victim’s injury.
Some Florida accident victims have Medicaid but do not treat with doctors who accept Medicaid. In this case, the adjuster may argue that the failure of a Medicaid beneficiary to use a doctor who accepts Medicaid means that the victim failed to mitigate damages.
Medicaid pays a fraction of a medical provider’s billed amount. The patient usually owes nothing. The liability insurer will argue that it is only responsible to pay the victim the Medicaid approved amount. This would decrease the full value of the personal injury case.
The victim should tell the adjuster that he or she is wrong. The injured person can cite a lot of Florida law to the adjuster.
The victim can cite Grell v. Bank Of America Corporation, Dist. Court, MD Florida 2007. In that case, the court said that the defendant “has not shown that [the victim] was able to or required by the collateral source statute to submit the additional medical charges to his health insurer.
The injured Medicaid beneficiary should also cite Parker v. Hoppock, 695 So.2d 424 (Fla. 4th DCA 1997). Parker said, “The very image of a plaintiff as one who accepts governmental handouts carries a substantial likelihood of prejudice that outweighs any marginal probative value.”
The Parker court also said:
“In the current political climate, there is no doubt that substantial social stigma may attach to one labeled as a welfare recipient. The type of testimony offered in this case, and then woven into closing argument, denigrated plaintiffs by implying that they would rather accept governmental hand-outs…The substantial prejudice flowing from this image is in addition to the prejudice arising from the nefarious image of a plaintiff trying to obtain a double recovery. See Gormley v. GTE Products Corp., 587 So.2d 455, 456 n. 1 (Fla.1991).; Cook v. Eney, 277 So.2d 848 (Fla. 3d DCA).
The victim should also mention the case of Florida Drum Co. v. Thompson, 668 So. 2d 192, 193 (Fla. 1996). In Florida Drum, the Florida Supreme Court agreed with the Fifth District Court of Appeal which held that regardless of the theory of recovery, negligence or contract, it was error to allow the jury to be apprised of the plaintiff’s insurance coverage.
The Florida Supreme Court held that an owner’s casualty insurance was not admissible to show that the owner failed to mitigate damages.
My thoughts: A Florida Medicaid beneficiary should use Medicaid benefits to get treatment. He or she should make a good faith attempt to make an appointment with medical providers who accept Medicaid.
Many Florida medical providers do not accept Medicaid. Medical providers who do accept Medicaid may often not have available appointments for weeks or months.
A Medicaid beneficiary should document his attempts to get medical treatment using Medicaid. This can weaken the adjuster’s argument that the accident victim intentionally did not use Medicaid so that the outstanding balances (out of pocket expenses owed) would be higher.
In Florida, if the victim can show that someone’s negligence caused his or her injuries, he can recover the out of pocket expenses. He or she may also be able to recover other damages.
Florida claims adjusters know that higher past medical billed charges increase the full value of a Florida injury case.
If the injured person is unable to find a doctor who will accept Medicaid, he or she can then get treatment under a letter of protection (LOP).
A LOP is a written document that allows an injured person to get medical treatment. It states that the patient pays the entire outstanding balance to the medical provider if there is a settlement. If the victim cannot get a settlement, then the bill would become his or her responsibility.
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