Proof of insurance letter is supposed to get bill paid for, but it could cause more trouble than it's worth...?

Question

I just moved and switched insurance, had some medical things paid for under the new insurance, then saw a new primary care doctor for the first time but bill was denied b/c "waiting period" not yet over for that charge...Then talked to the doctor's billing company who said that if I supply a "proof of insurance letter" from my prior employer that it would demonstrate there was no lapse in coverage and this would solve the problem--great, because I knew my new insurance started a day after I quit the prior job.

However, when I called my prior employer to get the letter, I learned that they had never gotten around to canceling my insurance policy! They then canceled it, and I got a "proof of coverage" letter, but noted that the letter stated that my insurance coverage ended only recently.

Thus, my new insurance company has been paying for things despite my old policy still being in place. Now I'm concerned if I submit this letter to the new company that they'll say they shouldn't have paid for anything because the other policy was active! (Even though I didn't know that)

I haven't done anything wrong (eg, I only asked one insurance--the new one--to pay for my medical care since moving, since that was the only insurance I thought was active), and I arranged in good faith for there to be no gap in coverage. However, I'm afraid that if I show this letter to the new company I'll just get a bunch of problems. Maybe I should just eat the new bill and not submit the letter. Any advice?

Answer 1

If there was less than a 63 day break in the coverage and you had the previous coverage for at least 12 months, that time would be applied to the waiting period you had with the new carrier. For example, if you had the previous coverage for 18 months and you had no break in coverage of less than 63 days and you had a waiting period of 6 months on the new carrier, that 18 months would be applied toward the waiting period and basically you would have the coverage.

It is probably best to ask your old employer to correct the certificate of coverage back to the correct date.Explain the current issues you have and follow it up with a letter to them, so you have a paper trail. If you don't they could correct it later, say after an audit and the carrier would take back the payments-then you would have a mess and possibly credit issues to deal with. The longer you wait to correct these things, the more difficult they are to handle later.

Answer 2

You need to provide the copy of that letter to your new insurance company.

I understand where you think that you might be making things "easier" to just pay this one claim out of your pocket and let your new insurance company remain unaware of the fact that the old policy didn't terminate when you thought it did.  But actually, it will make things worse for you in the long run for several reasons...

1)  You did nothing wrong (yet).  It is completely legal to have more than one health insurance policy at a time - in fact, it is quite common for people to have dual coverage.  The companies would just coordinate benefits and determine who should make the primary payment.  (There is a standard set of Coordination of Benefits rules that the companies use to make this determination.)

2)  It would be insurance fraud to withhold the information from your new insurance company.  Most likely, your new insurance policy contains a clause that requires you to disclose any overlapping coverage.  You didn't know about the overlapping coverage before, and that's understandable.  It won't get you into trouble.  However, deliberately withholding the information now that you are aware of the situation could cause problems for you.  It would technically be insurance fraud, and I'm sure that's not your intent.

3)  Right now, its just one claim that you're thinking about paying out of pocket.  But who knows how many more claims will pop up during your waiting period that you will be liable for?  You have the coverage and are legitimately entitled to have your insurance company make payment.  Don't cheat yourself and create more potential problems in the future!

4)  If your new insurance company finds out about the old one in the future - even if it happens a few years down the road - they can still go back and dispute the coordination of benefits information.  That would be an even bigger headache for you!  Right now, your accounts are still current, and your healthcare providers would be more understanding about the situation.  Its much easier on everyone involved to try to sort this information out now, rather than have it come back to haunt you several years from now.

I would definitely submit the letter.  As you said, you haven't done anything wrong.  The insurer may have to review some information, but ultimately it will get sorted out.  The 2 insurers will figure out who had primary responsibility for the bills during the period where the policies overlapped, and then proceed from there.

And as a bonus, you aren't going to get stuck with bills that you shouldn't have to pay, just because you were afraid to disclose the new policy.  :)