Employer didnt pay insurance bill-cancelled!

[RobertG]

What is the name of your state? Florida

I have (had) insurance coverage through United Healthcare via my employer. Last week (July 11), I received notice from them that my plan was cancelled as of JUNE 1! During the time period between June 1 and now, my wife has undergone some major medical work that amounts to $1000's in claims. According to United HealthCare, all of those claims will be denied due to my employer not paying the bill. He did withhold the money from my paychecks. I am only one of 2 employees, so this does not affect many people.

As for additional information about the situation, United HealthCare refused to provide me with any other information, saying I had to contact my employer for additonal details. My employer is blowing it off like it's unimportant at this point!

What do I do now??!?!? I do not have anywhere near the money to pay the medical bills that I will now be responsible for. And, additionally, if something bad were to happen right now, I HAVE NO INSURANCE.

A few years ago, I had my gallbladder removed [the attack was so severe that it was life-threatening] and the hospital stay [2 1/2 weeks in the hospital, about 10 different tests, and 2 surgeries due to complications] rang up an approx $80k bill--all 100% paid by insurance--I had a really good plan at the time. If that were to happen to me today, it would financially ruin me, all because my employer didn't pay his bill.

I am not eligable for an individual plan either, due to my medical condition (diagnosed with Sleep Apnea), although I've had health insurance for over 20 years in Florida.

What options do I have? And, whatever happens must happen quick, because in Florida, I believe after 3 months of no coverage, I go back to everything being pre-existing conditions!

[cbg]

Just so you know, cancellations of insurance due to non-payment are ALWAYS retroactive. To give you an example of why this is (and I am a former employee of United Health Care - AND in their small group division - so I know exactly how they do it) the bill for June 1 would have gone out on or about May 20. When payment was not made by roughly the middle of June, there would have been a reminder sent out (possibly more than one) to your employer. When payment was not made by 30 days after it was due, cancellation would have been made retroactive to the last day for which they had received payment; June 1 (May 31 would have been the last day for which they had received payment).

UHC is not "blowing you off"; their contract is with the employer, not with you. They cannot give you details of a contract to which you are not a party.

Your employer must do one of two things; refund you the premiums which he deducted from your paycheck, or pay UHC so that the coverage is reinstated. A third option is to find new coverage with another carrier, but unless he could coax one to make the coverage retroactive to June 1, unlilkely at this point, he would still have to reimburse you for the premiums deducted for the time you are uninsured.

If he refuses to do either of the options above, you can complain to the US DOL about a possible ERISA violation. However, at this point it is between you and your employer. He is not obligated, under the law, to provide you with health insurance (Hawaii is the only state where it is obligatory for employers to provide health insurance to their employees). If he chooses to refund your premiums, he has done all he is required to do under the law. It is not his responsibility to see that your medical bills are paid.

[TIMMAAYY]

RobertG said - "I have (had) insurance coverage through United Healthcare via my employer. Last week (July 11), I received notice from them that my plan was cancelled as of JUNE 1!"

Wow.... that bites.

I would contact your employer and ask of they are going to be reinstated and pay the back premium retroactive to June 1st so you have no "gap" in coverage.

And your lapse before anything is Pre x'd is not three months, it's 63 days ( federal law ).

Unfortunately, as CBG said, you may be screwed. If so, may I suggest this:

Contact the hospital or provider who performed the procedures on your wife. Explain to them the situation. Negotiate a payment plan or fee. You'd be surprised how often this is done. It's not always accepted, but it's certainly worth a try.

The "bill" from the provider is usually incredibly high. The insurance company ( United in this case ) has a negotiated rate or price for the services provided, which are substantially less. For example, your original bill may have been 50k, but United may say the provider can only charge 4k. This is what they were expecting to get, not 50k. This is the "allowable" amount they can charge according to United.

Sadly, you won't be able to find out what the "allowable" amount was, because your EOB ( explanation of benefits ) will show that you did NOT have coverage at the time.
I have seen ER bills that were originally $8k, and were knocked down to $800 on the "allowable" amount.

If you are truly stuck with the bill, try to negoatiate an offer to settle it without going bankrupt. More often than not, I have seen the provider take the offer rather than fight with you and wait for payment they may never receive if you are forced into filing bankruptcy.

EDIT

If your employer does not reinstate with United and is not planning on getting you group insurance again, you are eligible for United's conversion plan.

I am looking for FL's high risk pool plans. also, as you would be HIPAA eligible if your employer is no longer offering insurance to you and you have been turned down for individual coverage due to your condition.

EDIT

It appears that FL's high risk pool has been closed for enrollment since 1991. Scratch that option.

[cbg]

Just to clarify - while Federal law sets a 63 day limit before pre-ex can go into effect, it does not mandate that one MUST be set at precisely 63 days, or at all. An employer, or carrier, or state law, can implement a longer period before imposing a pre-ex clause; it simply cannot do so for under 63 days. So it's not impossible that the poster may be looking at a 3 month period.

[TIMMAAYY]

Gotcha.

[RobertG]

So, does anyone know the "real" amount of time one has in the state of Florida before PreExistings take effect again? I really cannot afford to not be covered, and have some pretty expensive Pre-Existings that I cannot afford.

I absolutely REFUSE to go bankrupt because an employer has decided to be stupid. Why the hell should I be penalized for life because of an employer's mistake? And, right now, if I were to have a major problem with one of my pre-existing conditions (some of which are possibly life-threatening), I'd be SOL, right? Time to move to Canada, where they CARE about their citizens, I think.

Doesn't anyone here see a MAJOR problem with this? Are we that stupid that we let this type of situation happen in America, where we are supposed to take care of our own!?!?!?!
Interestingly, I went and saw the movie Sicko last night, and I have to say it definitely made me SICK.

I'd pay the damn premium MYSELF to UHC just to keep the insurance until they fix this. But, there isn't even anyone to speak to there who can do anything for me. It's like I'm the enemy and they are just this goliath that just wants money and doesn't really care about ANYONE but their CEO's and stockholders. Pathetic....

Oh, and about them hiding behind not having a contract with me, but with my employer instead, that is purely BS. MY MONEY pays for the insurance (I pay 100%--there is no employer contribution in my case). MY NAME is on the insurance card. I have MY OWN subscriber ID. I had to SIGN the forms for my insurance. And, MY HEALTH is at stake. My employer just made the arrangements. So, them hiding behind some crap about them only having a contract with the employer is just an excuse.

[moburkes]

Robert, just pointing out something that you haven't realized. If your wife's major medical work was urgent, you would have still had it done, right, even without insurance?

In any case, there is unlikely anything you can do. Let's say your employer caught up the premiums, which gives you a sigh of relief. Let's say he cancels the policy, though, going forward. There's nothing that you can do.

[cbg]

Robert, you're still misunderstanding something. It is up to the individual carrier how long it is before they implement a pre-ex clause. There is no law in Florida, or any other state, that says all carriers must implement pre-ex at exactly this time and no other.A carrier can choose to do it at 3 months, or 6 months, or a year. A carrier may even waive pre-ex. They simply cannot implement it at less than 63 days (Federal law).

No, it is not BS that the contract is with your employer. You may have signed the enrollment form and you may even be paying the premium. But your employer negotiated the contract, it's his name on the plan contract (not yours) and the rates are based on the GROUP benefits, not yours individually. Yes, I understand that you are a member with an ID card and have your coverage under the contract, but you are not the primary - the employer is. It's not just an excuse; that's the way group coverage works. The employer is the primary. The employer is the one that writes the check, even if it's money deducted from your check. The employer is the one with the responsibility for payment. The employer is, to all intents and purposes, the owner of the policy. The fact that you are covered under the policy does not make you the contract holder.

[RobertG]

Originally Posted by cbg

Robert, you're still misunderstanding something. It is up to the individual carrier how long it is before they implement a pre-ex clause. There is no law in Florida, or any other state, that says all carriers must implement pre-ex at exactly this time and no other.A carrier can choose to do it at 3 months, or 6 months, or a year. A carrier may even waive pre-ex. They simply cannot implement it at less than 63 days (Federal law).

No, it is not BS that the contract is with your employer. You may have signed the enrollment form and you may even be paying the premium. But your employer negotiated the contract, it's his name on the plan contract (not yours) and the rates are based on the GROUP benefits, not yours individually. Yes, I understand that you are a member with an ID card and have your coverage under the contract, but you are not the primary - the employer is. It's not just an excuse; that's the way group coverage works. The employer is the primary. The employer is the one that writes the check, even if it's money deducted from your check. The employer is the one with the responsibility for payment. The employer is, to all intents and purposes, the owner of the policy. The fact that you are covered under the policy does not make you the contract holder.

And, with what I've seen in Florida with insurance (the land of the hurricanes and 3/4 dead people), they'd start pre-existing at 2 days if the laws would let them. I've never found an insurer down here that extended it past 63 days and I did a lot of research on insurance before I broke down and settled for working for this person to get insurance coverage. Nice in theory, but in reality, the only thing that insurance companies care about is their bottom line and NOT paying claims. And, if there is any legal means (like the 63 days) that they can use to refuse claims, they will do it. Anyone who believes otherwise is living in a fantasy land.

[RobertG]

Originally Posted by moburkes

Robert, just pointing out something that you haven't realized. If your wife's major medical work was urgent, you would have still had it done, right, even without insurance?

No--she'd been living in pain since she was a little girl. Once we got married and I got her on my insurance plan, I told her that I could not stand to see her living that way (she's my wife and deserves better than that) so we got it taken care of. We could not have afforded to do that if we didn't have insurance.

[cbg]

You asked what the "real" point is at which pre-existing clauses go into effect. I gave you the correct answer, which is that as long as it is not less than 63 days, it's up to the carrier. Sorry you don't like the correct legal answer.

[TIMMAAYY]

If you're employer isn't going to re up with United, contact them yourself about their "conversion plan". It's going to be awfully pricey, most likely, but they MIGHT.... and I stress MIGHT... allow it to be effective the date your regular group insurance was cancelled. Tell them what happened.... and see what the options are for the conversion plan.

If that does not work for you, call the providers and negotiate a fair deal. Tell them exactly what happened and see what you can work out. A lump sum settlement, payment plan, etc. Your situation is not uncommon.

FL is not trying to "screw you". I have clients with plans from darn near every carrier in the Midwest, and I have NEVER seen any of them offer a longer period than 63 days. That's the law, and that's the most favorable to them.

Call UHC back and don't hang up until you get to someone who will help you into the conversion plan. They'll ask for your member no. etc. They will show you as cancelled. Ask them about enrolling in the conversion plan from your group, since your group is on more. Every state is a little different on conversion plans, and I am not familiar with FL. Don't be shocked if it's even more than your COBRA rates would have been.

If THAT doesn't work for you, contact other carriers such as BCBS and ask them if they have "guarantee issue" plans. Again, these will be very expensive.

Good luck.

EDIT

Here is the link to the information about the conversion plans and Florida law...

[url]http://www.fldfs.com/Consumers/literature/health_guide/hig_09.htm[/url]

[Insurance Pro]

[QUOTE=cbg;1676191]Robert, you're still misunderstanding something. It is up to the individual carrier how long it is before they implement a pre-ex clause. There is no law in Florida, or any other state, that says all carriers must implement pre-ex at exactly this time and no other.A carrier can choose to do it at 3 months, or 6 months, or a year. A carrier may even waive pre-ex. They simply cannot implement it at less than 63 days (Federal law).

In fact, most states DO have statutory language that specifically spells out the laws regarding pre-existing conditions as well as when the exclusion period for those conditions may begin. Normally, the exclusion period for pre-x begins on the "effective date of coverage" for the plan. Additionally, the "63-day" stuff you are reading only has to do with what is referred to as "creditable coverage" under HIPAA, and is federal in scope. Each state has it's own individual laws and rules, but must still adhere to HIPPA when it comes to the creditable coverage (or "portability" aspect of HIPAA) and cannot simply instutute their own sets of laws and rules.

Please post another questions if you are concerned specifically about creditable coverage.

EDIT: click here for link to Florida's statute concerning pre-x: http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=Ch0627/SEC6045.HTM&Title=->2007->Ch0627->Section%206045#0627.6045

[cbg]

I think you misunderstand my point.

I fully understand the concept of creditable coverage and I understand that states can and do implement statutory language regarding pre-ex conditions.

Robert is looking for an across the board, carved in stone answer that all carriers will be required to use regardless.

Say, for the sake of argument, a state statute grants a carrier the right to implement pre-existing conditions after a gap of six months.

A carrier could still opt not to implement pre-ex language at all. Or they could allow for there to be a gap of 12 months before they implemented pre-ex language.

I am not aware of any state under which ALL carriers are REQUIRED to implement pre-ex language at a carved in stone point in time, with no exceptions or waivers permitted, and that is what Robert is looking for.

If you have knowledge to the contrary please share it.

[Insurance Pro]

cbg,

I am at the mercy of semantics. Here's what I'll give you...

Pre-x waiting periods normally begin upon the date of enrollment (group) and effective date of coverage (individual). Given that there is no specific requirement to enroll or purchase at any specific time, I'll have to admit that you are, in fact, correct.

Oooooh...that hurt! lol BTW- we're trashing this thread, I'm done