Mar 30, 2017

Mellor v. Wasatch Crest: Coordination of Benefits Between Insurance and Medicaid


Blog Category:
3/15/2009
Brian S. King
Comments (0)

More about Mellor v. Wasatch Crest, 2009 UT 5, and its coordination of benefits discussion. About a year before his drowning accident, Hayden’s father’s employment terminated and Dad elected COBRA coverage for his family, including Hayden. The accident brought weeks of hospitalization and mounds of medical expenses. Hayden’s mother applied for Medicaid coverage and coverage was approved retroactively to two days before the accident. Mom continued to pay COBRA premiums for the insurance coverage. But when the insurer got wind that Hayden was on Medicaid, it argued that the terms of its policy made it secondary to Medicaid. Medicaid disagreed. The trial court ruled in favor of the insurer. That’s when I got involved in the case and appealed to the Utah Supreme Court.

The decision from that Court made short work of Wasatch Crest’s argument. Both the language of COBRA and the terms of the insurance policy made it clear that while the insurer may have been able to cut off its obligations to provide primary coverage for its insured if he began to collect Medicare, the same is not true of Medicaid. As between that needs based taxpayer funded benefits program and private insurance, the insurer will always be required to provide primary coverage.

Mellor v. Wasatch Crest
makes clear that insurers of Medicaid eligible insureds are not able to shift the costs of medical care to taxpayers. That’s a good thing for the taxpayers.



Category: General


2 Comments to "Mellor v. Wasatch Crest: Coordination of Benefits Between Insurance and Medicaid"

Thanks for your comment Don. It was fun to litigate. The oral argument before the Court was memorable because the Justices focused right in on a number of weak points in the insurer's case. It was clear by the end of that half hour of discussion how they were going to rule. And that really isn't that common in oral argument.
Posted by Brian S. King on March 20, 2009 at 11:02 PM
Brian:
This seems like an easy case to litigate.
The other position confirms the difference between genius and stupidity: genius has its limits.
Don Levit
Posted by Don Levit on March 17, 2009 at 10:19 AM

Post a comment

Post a Comment to "Mellor v. Wasatch Crest: Coordination of Benefits Between Insurance and Medicaid"

To reply to this message, enter your reply in the box labeled "Message", hit "Post Message."

Name:*

Email:* (will not be published)

Message:*

Notify me of follow-up comments via email.