Will my health insurance cover treatment for chronic back pain after a settlement?
A few years ago, I injured my back after falling in a business due to a hidden hazard. Although my settlement was not large, I received about 25% of it, which I used to pay off some debts.
Recently, my back pain has returned and is now far worse than it ever was before. Coughing causes severe discomfort, and I find myself needing to brace my back against something solid.
One aspect my lawyer didn’t clarify was how my health insurance would work in this situation. Sadly, he passed away shortly after my settlement, and I don’t have a new contact at the firm.
If I decide to see a doctor now, what will happen in terms of my insurance? I’m unsure if the current pain is related to my previous injury. Could they refuse to cover it? Might they seek a portion of my settlement? Would I be responsible for repaying the full settlement amount or just the portion I received?
I do have some savings that are not linked to the settlement, but unfortunately, the settlement money has already been spent.
I’m sorry to hear about your situation; chronic pain can be really challenging to deal with. Here’s a breakdown of what you might expect regarding your health insurance and treatment for chronic back pain following a settlement:
Health Insurance Coverage: Generally, most health insurance plans will cover medical treatment for chronic pain, even if it’s related to a prior injury or settlement. The key is whether the treatment is deemed medically necessary. It’s a good idea to check directly with your insurance provider about specific coverage details.
Connection to the Settlement: Since you’ve received a settlement for your injury, your insurance may inquire about whether your current condition is related to that injury. If you believe your recent symptoms are connected, it’s important to be honest about that when speaking with healthcare providers and your insurer. However, if you feel the pain is unrelated, you should communicate that as well.
Subrogation Clauses: Many health insurance policies have a subrogation clause, which allows the insurer to recover costs incurred for treatment related to an injury if you receive a settlement. However, this usually only applies to the portion of the settlement that compensates for medical expenses. If your settlement was primarily for pain and suffering or lost wages, this could complicate matters.
What Happens After You Go to the Doctor: When you go to the doctor, your treatment will typically be billed to your health insurance first. If the treatment is covered, your insurance may pay their portion, but they may later request reimbursement if they find the costs are associated with your previous injury settlement. This doesn’t usually mean you owe them the full amount of the settlement, only what they paid for your treatment.
Consult with a Professional: Given the complexity of your situation and the specifics of health insurance policy language, it might be beneficial to consult with a healthcare advocate or another attorney who specializes in personal injury and insurance claims. They can help clarify your rights and obligations regarding your health insurance and any potential reimbursement issues.
Overall, your best course of action is to move forward with seeking medical treatment while also gathering information on how your specific insurance policy handles cases like yours. Wishing you the best for your health and recovery!