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Workers Comp, BC/BS and Medicare
#14
(03-06-2018, 03:23 PM)California_Help Wrote:
(03-05-2018, 11:16 PM)Shadow Wrote: 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."


So how does this affect an injured worker that sold the medical ?

Is this specific clause that you have posted legally binding on a private insurance companies reimbursement and subrogation rights ?

What you have posted could lead an Injured Worker to believe their work related injury or illness is still covered regardless of releasing future medical.

No one disputes the ACA covers pre existing conditions. How does this relate to to the original question.

The original poster asked if another would accept liability after the medical is sold out for a knee injury.

The answer is no !

Just call the private insurer and explain you have this work injury , sold the medical and now want them to pay for care .. no problem right?

Just let the treater know that you have this work injury and are now billing private insurance , you sold the medical... no problem right ?

Cite the affordable care act if you get a denial for a preexisting condition with an existing or preexisting liability Smile

The ACA 's pre existing condition clause and an insurers right to recovery are two completely different issues.

Injured Workers beware of this misinformation. Sell your medical ..you're in a really bad place if you need medical care. You are not covered.

No one can provide a health insurance policy that accepts liability for a workers comp claimant that sold their medical ... no one ..ever !!

Please post it Smile

There is no "liability" for a closed work comp claim in regards to private insurance. The same goes for people who have injuries that resulted in a civil award.

I do not believe there are links to what you are asking for because it is a non issue as private insurance covers ALL preexisting conditions, unless you purchase private insurance outside of the enrollment period as those policies do not have to abide by rules of ACA or cover preexisting conditions.

The article 1171 posted states people with closed WC claims will be paying for insurance premiums, co-pays and deductibles. They are not getting a free ride.


The private insurance policies are very clear on excluded work injuries. People can spin it all they want .The liability is on the worker now ..they sold out. Civil awards typically don't have an FMC award ..some do and money is placed in a trust. Civil claims typically seek subrogation and reimbursement when the case setlles . An auto accident will run trough the private insurer . I personally had to use all of my MED PAY on my auto first , then private insurance paid and went after the responsible party.

Two things you do not recognize 1- The policy excludes work related injuries. 2 - The ACA does not eliminate a private insures right to reimbursement where there is existing liability for a pre- existing condition.

The article 1171 posted is interesting. So is the video and it's specific language.

Just look at the exclusions in a typical policy ..they go on and on, not just workers comp , acts of war and countless other exclusions.

To lead someone to believe the ACA covers everything is just simply false.

If you go to an honest doctor here in Ca , try to bill private for a sold out wc medical ,they will turn you away

I know people that are cost shifting this way, they are withholding information and making mis- representations to obtain coverage.

Walk in to Kaiser and try to cover your work injury using your private insurance. Smile Especially if Kaiser was in the MPN to begin with.

What I am asking is : Can anyone on the WWW show a private health insurance policy ( in 50 states ) that does not have a workers comp exclusion ..the answer is no.
 
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Messages In This Thread
RE: Workers Comp, BC/BS and Medicare - Shadow - 03-06-2018, 04:12 PM

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