Health Insurance cancelled without notice.

[gmgutman]

What is the name of your state?What is the name of your state?What is the name of your state? Florida

WHAT A MESS: When I left my last position as administrator of a group medical practice (August 30, 2002), I informed our insurance agent that I would be going on COBRA effective October 1, 2002. I completed the necessary paperwork for United Healthcare and paid monthly premiums to my ex-employer.

Effective April 1, 2003, my ex-employer changed to Aetna. Their insurance agent informed me of the change and sent me an application for Aetna. I completed the application indicating that I was on COBRA. Somehow, the fact that I had applied for COBRA was missed and I was enrolled as a full-time employee although I was no longer. (Yes, I do have a copy of the original application.)

I paid my ex-employer for my February 2005 premium. Also in February, I got sick and spent a week in the hospital. Upon discharge, I went to have my prescriptions filled at a local drug store only to find that my insurance was cancelled as of January 31, 2005. This, needless to say, was a surprise since I was not notified.

When I called my ex-employer, they told me that they had recently discovered that I had been enrolled as a full-time employee, that had I been enrolled in COBRA it would have long expired, and that their attorney advised them to cancel me immediately because it was misrepresentation of fact.

Since I had only 2 weeks to enroll in an Aetna individual conversion plan (the priviledge extends for 30 days from termination), I felt pressured and had to follow through with this because of my poor medical history. Although Aetna agreed to backdate my coverage to February 1st, I am now paying twice the premium for about 1/2 the coverage I had. Before it was an open access HMO paying 100%, now it is a strict HMO with no out-of-network benefits.

Question: Is it legal to terminate health coverage, as in my case, without notice? If not, how have I been damaged? It could be argued that I benefited because I was covered with relatively cheap insurance beyond COBRA expiration.

Question: Since I had paid my premium for February 2005 and the check was cashed by my ex-employer, shouldn't they be responsible for those medical bills that will be denied under the new HMO plan that would have been covered under the old plan?

Thank you in advance for your advice.

 

[cbg]

You would have been notified when you first elected COBRA of the appropriate dates. COBRA is not unlimited; it is for 18 months only. While there are a couple of circumstances where this can be extended, they do not apply here. The company is NOT required to notify you when it is up. Although many do so as a courtesy, they are not required to do so by law. It is up to you to keep track. If you didn't do so, that's not their problem.

Due to the error, you received almost a year's coverage that you were not entitled to. I see no reason why your employer should pay for bills that never should have been covered by their plan in the first place. They should, of course, return your February premium if you are not going to be covered on the Aetna plan for that month. But that's all you're entitled to.

 

[gmgutman]

But...

Florida

I very much appreciate your comments, however, technically I was not on COBRA because I was enrolled with Aetna as a full-time employee. Aetna wanted to put me on COBRA in January 2005 when they received notice that I was no longer an employee, but the ex-employer did not want them to do that. I have no idea what their objection was. Thank you.

 

[cbg]

The fact that you mistakenly were coded as an employee when you are not, does not entitle you to additional COBRA time. You have received all the coverage, and more, that you were entitled to under the law. It doesn't matter why the employer doesn't want to keep you on the plan any longer; he's not obligated to.

 

[lkc15507]

Florida

I very much appreciate your comments, however, technically I was not on COBRA because I was enrolled with Aetna as a full-time employee. Aetna wanted to put me on COBRA in January 2005 when they received notice that I was no longer an employee, but the ex-employer did not want them to do that. I have no idea what their objection was. Thank you.

By January 2005 your COBRA should have long since been exhausted. The fact that it had not been is obviously an error that even you seem to acknowledge. Your ex-employer actually seems to me to be very generous to have suggested continuing COBRA in 2005 because of that error. What is not in question is that your actual employment terminated in August 2002 and you received COBRA information appropriately at that time. It does not matter that the paperwork may later have erroneously reported you as an active employee, the reality is that you were not and are therefore not entitled to active coverage for that period of time. The Summary Plan Description should clearly outline the requirements for eligibility for coverage based on hours worked. It would also describe COBRA coverage and when it terminates. I agree 100% with cgb that you were and had been in receipt of proper notification for very long time in regard to when your COBRA coverage should have terminated. Your ex-employer & Aetna are under no obligation to continue their error once found. I hope I haven't offended you, but plan participants are always, but always responsible for their insurance usage. If you were in receipt of a plan description and the initial COBRA notification, then you were duely notified, error or not. I would be quite surprised that Aetna does not require your employer to cover any benefits that were paid during the extended time you received but were not entitled to COBRA as it is the employer's responsibility to notify the carrier census status changes. Unless of course, it was their clerical error by recording the incorrect information, but from your post, that doesn't seem to be the case. Again, Aetna has no responsibility to cover anyone except as outlined by their plan description and within applicable state and / or federal guidelines. Personally, I think you are very fortunate that Aetna agreed to back-date your conversion policy coverage to Feb 1, not to mention having had that option at all. Although my comments my seem somewhat harsh, I really hope the best for you and that you can find a suitable alternative to your conversion policy if it does not work well for you.

lkc15507

 

[gmgutman]

Thank you all very much for your input and comments. It appears that I'll just have to accept things as they are.