Medical Insurance canceled after checking that we had it.

Question

My husband switched jobs, but up until his last check insurance was deducted. He still rec'd a check in Feb, but his last day of work was sometime during the last week of Jan. To make a long story short the only time we could get into the Dr was in Feb . ( baby needed shots, so there wasn't any immediate appointments available. Well, there were 2 other occasions where I went to the Dr. during that month, and prior to going I checked Insurance websites and called to confirm coverage. They were all a 'go'. Well, I don't know if at the pediatrician's office if they just proicess billing slower then other doctors,but when they went to submit their bill, they were denied. That Dr. appt was during the 2nd week of Feb, I called the insurance company and asked them how they can just denie a claim that when we went to the dr, we were at the time covered. The Insurance co told me that his employer had canceled our insurance as of Feb1. What I don't understand is that the other dr. appts we went to was covered, but from where maybe this one occurence they submitted the bill too late or something, in order to 'get it in'.

Is there any recourse that we can take? I'm now getting a bill for 500$ from the pediatricians where the INsurance was canceled, the end of Feb, but the employer said it was to take effect Feb1. How can they do that? Just take 'back' the use of insurance that at the time you thought you had?

Answer 1

His last day worked was in Jan-so he was being paid for Jan hours and benefits. When employment terminates, it takes time for the employer to notify the carrier and time for the carrier to update their records. An insurance verification at the time service is rendered is only verification that at that time, the person shows eligible. That can (and in your case, did) change. It makes little difference when the claim is actually submitted-as long as it's within the service year. The payment is based on the date the service was rendered and not the billing date.

The dr visit's that were paid erroneously will be corrected. The insurance will request a refund on benefits paid and you will receive a bill for the full amount from the doctor.

At the time you went to the doctor, you knew (or should have known) that you did not have the coverage since your husband was no longer employed there and the premiums were not being paid. I'm sure he received info upon his separation about when his benefits would cease and probably also received info on COBRA to extend his benefits if he so wished.

Bottom line is, the services were rendered, you were not covered and you will be billed for them. If it were me, I would contact the doctor and set something up for payment now. These things have a way of getting sent to collection and then your credit will be effected.

Answer 2

If your husband's last day of employment was in January, you should have been aware that your coverage would not be in effect during February.

The fact that you checked with the insurance company is irrelevant - there is often a time lag between the time an employee quits and when the employer is able to notify the insurance company.  If your family had any questions about what date the coverage would end, those questions should have been directed to your husband's former employer, not the insurance company.  It was your husband's responsibility to verify that information before he left his previous job.

Also, you won't be receiving notice from the insurance company.  What will happen is that the insurance company will take back the payments made to the doctor's office once they catch a claim paid after your coverage ended.  And then your doctor's office will come after you for full payment.

Its really in your best interest to get that cleared up now, because it will come back to haunt you eventually.  (Depending on the laws in your state, the insurance company can take back the payment even a couple of years down the road.  And then you'll find yourself in collections for something several years old...your doctor's office might not be willing to work out a payment plan for your either, since you could have avoided all the hassle on their end by fessing up now.)  Unless you'd rather take the risk of having it show up on your credit report a couple of years from now and having to deal with it then.

Answer 3

You didn't have coverage and you didn't pay for coverage for February so nothing in February would be covered.  You should have been eligible for COBRA and should have taken that if you wanted any bills to be paid for in February.  Naturally when you called it hadn't been cancelled yet, but you have no recourse.

It doesn't matter when they submit the bill.  A doctor could sumbit one now for an appointment you had in January and that would be covered because you were covered then.

Expect to hear from the insurance company.  Some times it takes a long time for it to come full circle.

Answer 4

Oh, the insurance company will be coming back to you, for reimbursement for those other doctor bills.  

The only reason you thought you had insurance, was because the paperwork for the cancellation hadn't caught up with the insurance company yet.  Nobody PAID for insurance for you, after February 1st.  You don't get it for free.  But your husband should have been offered the opportunity to continue coverage, at his cost, through COBRA.