Wife kicked of my insurance. Can she get Cobra?

[leevena]

This can be easily resolved, or it can be denied, so bear with me.

Your appeal should include proof that you submitted the required information in a timely manner. Your word of doing this is unfortunately not sufficient. So, if you mailed, did you use some form of signature for delivery? If you emailed, you could show proof.

Did you submit all the information together, meaning your wife and daughter, or was is separate? If the information was submitted separately it could explain why the activity for your daughter but not your wife.

 

[junkman]

Your wife was eligible on a given date. If she applied timely, all else is clerical error. Apparently the application was timely or she never would have been enrolled.

Who are you talking to? You need to get to someone with authority to make another decision. Be nice.

Get a copy of the plan certificate. You need to know what it says in writing about eligibility.

This should be easy. Perhaps this is a self funded plan and the company would like to duck the claim.

Write down the timing of events including applications and notices received. She would be Cobra eligible unless she was termed retro to her effective date and your premiums refunded.

 

[leevena]

Your wife was eligible on a given date. If she applied timely, all else is clerical error. Apparently the application was timely or she never would have been enrolled.

Who are you talking to? You need to get to someone with authority to make another decision. Be nice.

Get a copy of the plan certificate. You need to know what it says in writing about eligibility. The plan certificate is not sufficient, he should review the SPD.

This should be easy. Perhaps this is a self funded plan and the company would like to duck the claim.

Write down the timing of events including applications and notices received. She would be Cobra eligible unless she was termed retro to her effective date and your premiums refunded.

 

[Mike Moore]

Thanks for all the help, everyone. I really appreciate it. If we sign up for ACA is that retroactive?

it can be in certain situations. call healthcare.gov and ask for an appeal to acquire a retroactive enrollment. you definitely qualify for a special enrollment, only question is if it would be for 4/1 or 5/1.

cobra should have been offered to you for april, at a minimum. if you qualify for subsidies you want an obamacare plan. if not, then cobra will be almost identical in price and value to obamacare.

 

[Mike Moore]

When we get the $500,000 hospital bill, maybe we just don’t pay it? The hospital is owned by my employer, funnily enough.

if you have $500000 available, they will find it. If not, how could you pay it? id report your employer to your state department of insurance and see what they suggest. you may want to find a lawyer.

as mentioned above, call healthcare.gov and see if you can get a retroactive enrollment. in these corona virus times, they may be more understanding of clerical errors and be open to helping you fix the situation.

 

[junkman]

I wouldn't bother with the insurance commissioner. (Thats certainly true for TN. The commissioner is worthless. I can give examples but that's another thread.) These are federal laws that the employer appears to be violating.

Nothing significant can happen from here as far as accurate recommendation until Cappy finds out the exactly what the situation is and reports back.

ie enrolled timely, termed when, termed why.

We need the information from someone at the employer with authority. He needs it in writing.

We also need to know what the carrier has in their records.

As a side note, carrier reps type into their database what they think you said and what they think their response was.

Ask the rep whether they took notes and have the notes read back to you. Have corrections made. Get a supervisor involved if you can't get what you want noted. KEEP your own notes. We log them into our CRM.

Carriers are only an agent's friend when you're perceived as needed. Think back to how quickly AVA commissions went to $0.

And, yes, this could but shouldn't degrade to where an attorney is appropriate. We've had carriers correct clerical errors simply by explaining the situation and asking how they think a jury would react given the same information.

 

[leevena]

it can be in certain situations. call healthcare.gov and ask for an appeal to acquire a retroactive enrollment. you definitely qualify for a special enrollment, only question is if it would be for 4/1 or 5/1.

cobra should have been offered to you for april, at a minimum. if you qualify for subsidies you want an obamacare plan. if not, then cobra will be almost identical in price and value to obamacare.

Mike...your statement about COBRA may not be accurate. There has not been a determination that the wife was even on the plan.

 

[leevena]

if you have $500000 available, they will find it. If not, how could you pay it? id report your employer to your state department of insurance and see what they suggest. you may want to find a lawyer.

as mentioned above, call healthcare.gov and see if you can get a retroactive enrollment. in these corona virus times, they may be more understanding of clerical errors and be open to helping you fix the situation.

Mike...your statement about the insurance department may not be true, it does appear that this group is self-Funded.

 

[LostDollar]

I am neither an agent or an hr expert, but thinking about my own experiences as an employee with employer plans, the three previous posts seem to my like very common sense advice, from people I know to be experienced insurance professionals, that I think should be addressed prior to other actions.

I doubt that it would be possible for a State Ins dept CSR or an attorney to render any assistance without answering questions that the insurance professionals have pointed out as issues. And, if the employee goes ahead and gets the answers himself, non-adversarial or non-confrontational solutions may emerge.

 

[junkman]

This is the type of thing that should be easy to fix but can easily go down hill by letting it drag on.