Allstate Primary Payer for Accidents Under Medicare Advantage Class Action

This class action brings suit against two related insurance companies, claiming they did not fulfill their obligations as primary insurers in the Medicare Advantage (MA) program. Allstate Insurance Company and Allstate Fire and Casualty, the complaint alleges, did not pay medical expenses involving injuries in a car accident. Medicare and MA Plans therefore had to pay the bills and they are now trying to recover these payments.

Part C of Medicare involves Medicare Advantage Plans, which allow Medicare recipients to sign up for insurance through a private insurer, such as Allstate. Medicare pays the insurer a fixed fee for each person enrolled and the insurer then acts as the primary insurer and pays the bills for the person’s medical treatments.

As a secondary payer, the complaint says, Medicare organizations “are empowered to recoup from rightful primary payers when they have paid for services that fell within overlapping insurance maintained by” persons with a primary payer. This happens, according to the complaint when Medicare ends up paying bills for medical expenses that should have been paid by the primary payer.

Despite the requirements, the complaint says that “primary payers rarely honor their obligations” where accident-related expenses are concerned “and, instead, take steps to ensure that the burdens for those accident-related medical expenses is borne by Medicare and MA Plans. Despite at times reporting as required by law[,] primary payers still very often fail to pay or reimburse at the required industry standard rates.”

Medicare and MA Plans then pay the expenses and must pursue the primary payers to recover those payments. In this case, they are seeking to recover from the Allstate companies.

The causes of action are the right to a private action in such cases and the direct right of recovery, both under federal law, as set forth in under 42 USC § 1395y(b)(3)(A) and 42 USC § 411.24(e), respectively.

The class for this action is Medicare Advantage Plans and downstream parties or assignees who have made a conditional payment for benefits from Medicare Part C, in the US and its territories, who paid for the medical expenses of an enrolled person where either of the Allstate companies

  • Was the primary payer because it settled a claim with a person enrolled in a Medicare Advantage Plan,
  • Settled a dispute about paying medical expenses with such a person, and
  • Did not reimburse Medicare Advantage Plans and downstream parties or assignees for the conditional payments when they settled with the person.
Article Type: Lawsuit
Topic: Insurance

Most Recent Case Event

Allstate Primary Payer for Accidents Under Medicare Advantage Complaint

October 9, 2020

This class action brings suit against two related insurance companies, claiming they did not fulfill their obligations as primary insurers in the Medicare Advantage (MA) program. Allstate Insurance Company and Allstate Fire and Casualty, the complaint alleges, did not pay medical expenses involving injuries in a car accident. Medicare and MA Plans therefore had to pay the bills and they are now trying to recover these payments.

Allstate Primary Payer for Accidents Under Medicare Advantage Complaint

Case Event History

Allstate Primary Payer for Accidents Under Medicare Advantage Complaint

October 9, 2020

This class action brings suit against two related insurance companies, claiming they did not fulfill their obligations as primary insurers in the Medicare Advantage (MA) program. Allstate Insurance Company and Allstate Fire and Casualty, the complaint alleges, did not pay medical expenses involving injuries in a car accident. Medicare and MA Plans therefore had to pay the bills and they are now trying to recover these payments.

Allstate Primary Payer for Accidents Under Medicare Advantage Complaint
Tags: Auto-Related Accident, Health Insurance, Insurance, Medicare Advantage Insurance Plans