I am getting fed up with how insurance companies are handling enrollments under the ACA. Today we had a pretty devastating case that I have no idea how will turn out. I have client who had baby and we placed the newborn on its own policy about a month after birth, the coverage was set up to start at birth.
We followed the case and made sure the policy was issued and the first premium was drafted and notified the client (it was set up on EFT). This occurred about 10 days after submitting the app, it had to be a paper app so things moved a little slower.
Today, I got a call from the client (good friend of mine) saying that he called in to BCBS with a question and was told that his son no longer had coverage. We found out in the end that the bank draft was returned to his bank 5 days after it occurred so they cancelled the policy due to non-payment. Additionally, the will not reinstate the policy because they claim that there is no 90 day grace period because the policy was never technically put in force to begin with.
We were never notified as an agency that this occurred until just now, the son's policy showed up in our electronic portal as "termed" there was never a lapse notice sent out or any attempt to reach out to us in any way during this time.
They claim they left the client a voicemail about the matter, the client says he never heard it. Now, I know him personally and he is a very attentive individual and good with money, although perhaps not as anal as some people about staying on top of things. From speaking with BlueCross AND his bank, no one knows why the money was returned to his account and neither is claiming responsibility, the bank account had sufficient funds at the time of the draft. BCBS is saying that they didn't do it and refuse to re-instate the coverage, now is son has no coverage, his post birth care was extremely expensive (in the mid six figure range) and the insurance company says we have zero recourse.
Are we already at the "hire an attorney" stage? What are we supposed to do as an agency to make sure this never happens? Beyond making sure the policy is put in force and the first draft occurs, I can't babysit every single policy to make sure it is all working, especially when there is no system in place to notify me of these occurrences until after it is too late.
We followed the case and made sure the policy was issued and the first premium was drafted and notified the client (it was set up on EFT). This occurred about 10 days after submitting the app, it had to be a paper app so things moved a little slower.
Today, I got a call from the client (good friend of mine) saying that he called in to BCBS with a question and was told that his son no longer had coverage. We found out in the end that the bank draft was returned to his bank 5 days after it occurred so they cancelled the policy due to non-payment. Additionally, the will not reinstate the policy because they claim that there is no 90 day grace period because the policy was never technically put in force to begin with.
We were never notified as an agency that this occurred until just now, the son's policy showed up in our electronic portal as "termed" there was never a lapse notice sent out or any attempt to reach out to us in any way during this time.
They claim they left the client a voicemail about the matter, the client says he never heard it. Now, I know him personally and he is a very attentive individual and good with money, although perhaps not as anal as some people about staying on top of things. From speaking with BlueCross AND his bank, no one knows why the money was returned to his account and neither is claiming responsibility, the bank account had sufficient funds at the time of the draft. BCBS is saying that they didn't do it and refuse to re-instate the coverage, now is son has no coverage, his post birth care was extremely expensive (in the mid six figure range) and the insurance company says we have zero recourse.
Are we already at the "hire an attorney" stage? What are we supposed to do as an agency to make sure this never happens? Beyond making sure the policy is put in force and the first draft occurs, I can't babysit every single policy to make sure it is all working, especially when there is no system in place to notify me of these occurrences until after it is too late.