Insurance has lapsed

[ndmommie]

What is the name of your state (only U.S. law)? PA

My husbands employer has been paying his insurance, or so he says. Since Aug, he has had four insurance companies... we keep getting new cards. Each of them has lapsed coverage, thank goodness we didn't use it. He is also covering myself, his wife, and our son.

Last month I decided to go see a doctor who requested an ultrasound. I have since learned from my GP that my coverage has been suspended. Neither his employer or the insurance company notified me. So as it stands I am now stuck owing the hospital $3000 for the ultrasound, and my GP for an office visit for a cold. After calling Aetna, they said it hasn't been paid and was terminated in Jan, and put in their system in Feb, yet we weren't notified ever.

I have called to talk to my husbands employer myself and he said some lie about late payment. His employer also owes my hubby thousands of dollars for not paying him for work, yet because of the the state of umemployment, my husband continues to work for him and only getting partially paid.

I do not trust this company one bit. My husband is in construction.

TIA

What is my recourse? Do I sue my husband's employer?

 

[cbg]

Sue him for what?

In 48 out of 50 states, including PA, employers are not obligated to provide health insurance to their employees. You knew that he had a history of allowing the coverage to lapse, but you went to the doctor without confirming that coverage was in force.

Surprisingly enough, the last time I looked there was only one state where the insurance company had an obligation to notify you of an insurance cancellation, and that state was not PA. While it would have been polite of the employer to notify you, he was not obligated to, particularly if he is still attempting to get the policy reinstated.

Your husband can file a wage claim for the money that is owed him, but unless he has a legally binding and enforceable contract or CBA guaranteeing health insurance coverage, I can't see any valid legal action with regards to the insurance.

 

[swalsh411]

So an employee has zero recourse against an employer who takes away a previously negotiated benefit?

 

[cbg]

There is zero evidence that the insurance plan was "negotiated" in this case. An employer has the right to change their benefit plans in the absences of a legally binding contract or CBA that says otherwise, and we have no evidence that such a contract exists.

 

[swalsh411]

Negotiation in the sense of coming to an agreement to work for an employer in exchange for a given pay and benefits package, not negotiation in the sense of a CBA or contract. But semantics aside I see your point.

 

[ndmommie]

Actually he was given health benefits by a prevailing wages package through a government job with this company. He has not been working on the government job, but this company still is subcontracting with someone who has government contracts. But now that's a whole other story.

Regarding the insurance, it was cancelled in Jan, but not put in the computers until Feb. So doctors visits weren't paid after Jan 12th although I had no knowledge and have spoken with the insurance companies in that time frame. I also had my husband ask his boss if they were covered and he said yes.... NOT.

And yes, no written contracts were ever signed by my husband... it was all a verbal agreement.

 

[cbg]

About the only thing I can suggest is that you contact the state insurance commissioner and see what they have to say.

 

[ariastar]

Has your husband been paying premiums on the coverage since it was canceled?