health insurance ?

[mingdurga]

What is the name of your state (only U.S. law)? New York

Will private insurer pay for arthroscopic shoulder surgery for injury suffered 7 years ago. No fault settlement 2 years ago, but surgery never done.

 

[Zigner]

What is the name of your state (only U.S. law)? New York

Will private insurer pay for arthroscopic shoulder surgery for injury suffered 7 years ago. No fault settlement 2 years ago, but surgery never done.

You'd have to ask your insurer...

But, if you were already paid for the surgery, why would you expect your private insurance to pay for it?

 

[ecmst12]

Is this an individual plan or do you have it through an employer? Is there a pre-existing condition exclusion?

 

[Zigner]

Is this an individual plan or do you have it through an employer? Is there a pre-existing condition exclusion?

OP was already compensated for the cost of the surgery. If the OP requests that the surgery be paid for by the insurance company, the OP may very well be committing insurance fraud.

 

[ecmst12]

That's not true. OP received a settlement for the injury. If he did not have surgery, he was NOT compensated for the cost of surgery. He was compensated for the treatment he DID have, and for the degree of functional limitation he demonstrated at the time, as well as pain and suffering. It's likely that it was not needed at that time. If there's no pre-existing limitation to worry about, then it will be covered and there will be nothing fraudulent about it. And it's very unlikely that pre-existing would be an issue since it was so long ago.