ATLANTA --- A Fort Gordon soldier injured in an auto accident is fighting in the Georgia Supreme Court to keep MCG Health Inc. from taking one-third of the money he got from the other driver's insurance company.
The hospital wants the $18,000 to pay his hospital bill.
It could submit a claim to the military insurance program, TRICARE, which would cover all treatments and let the soldier, Sgt. Braxton Morgan, keep the $50,000 he got from Yvonne Adams' insurance, Owners Insurance Co. If MCG Health takes payment from TRICARE, it only gets 40 percent of the treatment costs instead of the full amount it wants from Morgan.
On Wednesday, Augusta attorney David Hudson argued on behalf of the hospital that what MCG wants to do is permitted under state and federal law.
Besides, he said, the soldier, Sgt. Braxton Morgan won't really lose any of the $50,000 settlement he was granted by the insurance company of the driver who caused the accident because Morgan's own car insurance should make up the difference to him through its underinsured-motorist provision.
"Sgt. Morgan isn't going to pay any of the debt," Hudson said.
The hospital has already lost legal decisions twice, in Richmond County and at the Georgia Court of Appeals. Both courts ruled that the hospital's only way to get paid is to submit a claim to the military's TRICARE insurance under the hospital's contract with TRICARE.
"What the Court of Appeals said is 'we are going to hold MCG to the bargain it struck,' " said an attorney for Morgan and Owners Insurance, Harry Revell.
Hudson told the seven justices that Congress created TRICARE with the idea that other insurance should pay up first, if there is any other insurance available.
State law, he said, allows hospitals latitude in collecting from patients -- or people who cause the accidents that trigger their hospitalization.
Several justices asked questions but offered no hints about which way they might decide. Ruling for Morgan and Owners Insurance would allow an injured soldier to keep the money. Ruling for MCG Health would allow state and federal taxpayers to recover the full cost of treating him and get it from the source of the accident.
Hudson said a ruling against the hospital could also prohibit other government health programs, like Medicaid and Medicare, from recovering costs in similar situations.
Reach Walter Jones at walter.jones@morris.com.
All I know is that I have Medicare and I was injured in a car accident, and I have to reimburse BC/BS and Medicare after I receive a settlement. I had to agree to it to get them to pay my medical bills.
Corg>>> medicare is different than Tricare. MCG and Tricare have a contract. In this contract all procedures are assigned dollar values. The contract also states that MCG cannot persue the Service member for payment beyond that amount. MCG needs to take the copay and be happy the patient was insured. You don't here them complaining about all of the crack whores and shot up thugs that enter their emergency room doors. They need to leave the Soldier alone.
C2Soldier MCG and Medicare have a contract, they have a contract with Medicaid, and they have contracts with commercial carriers and it is FRAUD to bill Tricare, Medicare, Medicaid, and Commercial carriers without exausting the benefits of the of the auto policies involved.
They will spend time and money trying to sweat the money out of this man. Might be better spent going after those who are uninsured or illegal
C2soldier, the medical providers that I received care from- including hospitals- also have contracts with BC/BS.
I had to agree to reimbursement to BC/BS and Medicare, otherwise I would be personally 100% liable for all the medical bills and they weren't going to pay. Why? Because I signed a legally binding contract- admission papers- when I was taken to the ER.
I just thank God that BC/BS and Medicare agreed to subrogate it- they didn't have to. (And they don't, that's perfectly legal.) And they wouldn't until I agreed to reimbursement to them.
He signed paperwork agreeing to be personally responsible when he was admitted for treatment at a civilian hospital- and that's where they are going to get him. Read all those hospital consent forms. They all say that.
And nope, it's not fraud.
I am in the middle of it- I KNOW.
People don't know just how vulnerable they are in cases like this and how the laws are stacked against them. Just because the sergeant wants Tricare to pay and he wants to keep the money, doesn't mean it happens that way.
MCG doesn't care about Tricare, all they know is that they have a legally binding, enforceable contract that Sgt. Morgan personally signed.
The really dumb thing is that Sgt. Morgan is going to pay way more than $18,000 in legal fees by the time it's all over with- win or lose.
Taking a case to the GA Court of Appeals ain't cheap. MCG has deep pockets, far deeper than Sgt. Morgan.
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