Question
What is the name of your state? MI
In 2001, I was with the employer 'EA' when I met with the car accident and had an injury. I was with health insurance company 'HA' that time and with the car insurance company 'CA' that time.
My health insurance company at that time 'HA', did cover just 40% of the treatment cost and sent the rest 60% to my that time car insurance company 'CA' to cover, under COB arrangement. The car insurance company refused to cover the cost and later, based on an advise from my doctor who threathened to send me bills, I ended up filing a lawsuit against the Car insurance company 'CA' and the driver who hit me. My lawyer was my doctor recommended lawyer. The settlement was reached in 2004 and 'CA' finally paid for the 60% of cost and Driver's party ended up paying for my attorney costs plus the compensation to me.
I had to sign a paperwork with the car insurance company 'CA' that I will not claim anything from them in future since the settlement was reached through lawsuit. (This was the first lawsuit in my lifetime and had a terrible experience! I just wanted to end it!)
Today, I am working for a different employer 'EB' and my insurance carrier is the same 'HA' but completely different plan,group etc etc....No connection with the previous employer 'A's health insurance at all. I am also with different Car insurance comapny 'CB' today.
My today's medical situation is that, I unexpectedly need another surgery for the same injury that I received through the car accident in 2001. Now that I can not claim from 'CA' due to paperwork, should my current 'HA' cover the complete cost of surgery? Is it necessary to mention to the doctor that it was through car accident, since the same injury can easily happen through sports and even regular labor work and the treatment/surgery is the same? Will 'HA' be able to connect my current injury/treatment with previous treatment record that they may have? My current 'HA' may ask me to cover the costs from 'CA' if they find that it's accident related. Can they? I need to find this information before I proceed with the decision about surgery. I can not afford to pay for the surgery even though I received the real tiny compensation though lawsuit. The lawyer took almost 85% of the settlement.
Experts, please advise, what are my options.
leogsb
Answer
should my current 'HA' cover the complete cost of surgery?
HA should cover the cost of the surgery to the point that the surgery is covered by the policy. That may or may not be the complete cost; no one can say without reading the policy.
Is it necessary to mention to the doctor that it was through car accident, since the same injury can easily happen through sports and even regular labor work and the treatment/surgery is the same?
Based SOLELY on what is in your post, I don't think it's necessary to answer any questions that are not asked, but if the doctor asks you how it happens, yes, you should tell him that it was through the car accident. You'd be an idiot not to, and you don't sound like an idiot to me.
Will 'HA' be able to connect my current injury/treatment with previous treatment record that they may have?
WILL they? Unknown. CAN they? Sure they can.
My current 'HA' may ask me to cover the costs from 'CA' if they find that it's accident related. Can they?
Unknown without reading the terms of both policies and any relevant documentation to the previous settlement.