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Workers Comp, BC/BS and Medicare
#10
(03-03-2018, 05:27 PM)goingback Wrote: To add to 1171's answer, Medicare will NOT pay for future medical treatment unless you follow the MSAA rules AND prove that you are out-of-pocket for future medical treatment in an amount equal to or greater than the amount of the set aside.

If the WC lump settlement is under $250K, and the parties agree NOT to secure Medicare’s approval in advance, there is a risk that Medicare will decide that the amount of the set aside for future medical treatment is NOT enough to protect their interest. This could impair your right to have Medicare pay for future medical treatment after you exhaust the amount of the set aside.

Every private health insurance contract is different. Thus, you would have to look to the terms of the policy first.
That being said, it is possible that a private health insurance company likewise would refuse to pay for any future medical treatment unless you prove that you are out-of-pocket for future medical treatment in an amount equal to or greater than the amount of the set aside.
If your work related injury is preexisting, a private health insurance company may refuse to insure you or may preclude you from being covered for any future medical treatment.

http://modicalawfirm.com/what-if-i-settl...-all-time/

https://www.healthcare.gov/coverage/pre-...onditions/

The above has information about pre-existing conditions. Grandfathered policies ended on 2014. Unless you purchase private insurance outside of the enrollment period they should cover pre-existing conditions.

"All Marketplace plans must cover treatment for pre-existing medical conditions.
•No insurance plan can reject you, charge you more, or refuse to pay for essential health benefits for any condition you had before your coverage started.
•Once you’re enrolled, the plan can’t deny you coverage or raise your rates based only on your health."
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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RE: Workers Comp, BC/BS and Medicare - California_Help - 03-04-2018, 07:58 PM

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