Health Insurance Active Date Fiasco

[redflash777]

What is the name of your state? Arizona

Here is my situation. If anyone can offer any insight, it would be greatly appreciated!

We applied for health insurance for my wife back in May. The only medical history she had was the removal of a small cyst in her wrist a couple years ago. The insurance company came back, as expected, in June asking for us to fax a form requesting medical records be sent to the insurance company. Well, we did that and didn't hear anything for weeks. Well, a week ago my wife got pregnant, had complications, and ended up needing surgery. She spent a night in the ER and a day in the hospital and took all kinds of tests. Several people told me that if she is approved for insurance, it should be retroactive to when we paid the application fee. Well, this past week I tried to track down the status of her application and it turns out they had never heard from the doctor's office. The doctor's office then acknowledged they received the request, but couldn't find her records. The doctor ended up writing a note just this week to explain what care she had received and that he couldn't find her chart. The insurance company proceeded forward and now wants to set her active date for tomorrow! That would obviously mean that we're on the hook for the entire hospital fiasco. Do I have the right to expect that her coverage should start with the application date? Do I have other options? We did everything we could, but the doctor's office held the whole thing up.

Thank you for your time,
Clint

[moburkes]

No, you don't. Sorry.

[cbg]

Is this individual or group insurance?

[ecmst12]

Insurance usually becomes active when you pay the premium, not the application fee...

[moburkes]

Originally Posted by ecmst12

Insurance usually becomes active when you pay the premium, not the application fee...

Hmmmmmmmmm. Application fee? I've never seen a health insurance policy with an application fee.

But, the policy doesn't become active until you're approved for coverage.

However, in your wife's case, she would have needed the surgery with or without the insurance. Also, does this insurance cover maternity? Was her surgery related to her pregnancy?

[ecmst12]

I hadn't heard of an application fee before either, but that doesn't mean much since I don't sell insurance and have never applied for private health insurance

[redflash777]

Its individual insurance. I pretty much figured that it wouldn't start until officially approved, but several people have told me that it can be retroactive to the application fee.

I'm surprised that several of you haven't heard of an application fee for insurance. I've always had to pay a $20-$30 fee, with multiple companies.

Thanks for the feedback! It looks like I might have to consider legal action against the doctor's office who failed to provide the medical records.

[cbg]

If it were group insurance, they would be required to make the date retroactive to the first date of eligibility. No such law exists for individual insurance to my knowledge. Sorry.

Stand by for Timmaayy to tell you why individual insurance is better anyway (wicked teasing chuckle).

[moburkes]

Originally Posted by cbg

If it were group insurance, they would be required to make the date retroactive to the first date of eligibility. No such law exists for individual insurance to my knowledge. Sorry.

Stand by for Timmaayy to tell you why individual insurance is better anyway (wicked teasing chuckle).

Haaaaaaahhhhhhhhaaaaaaaaaaaahhhhhhhhhhhaaaaaaaa!
I agree with the wicked chuckle!

[ajkroy]

The application was in May and her surgery was in August. Why didn't you follow up with the doctor's office to find out if they sent the records or even recieved the request? Or follow up with the insurance company to see if her records had arrived?

I agree with moburkes -- she would have needed the surgery whether you had insurance or not. It doesn't mean that you aren't liable for the bills.

Question: if your wife HADN'T needed surgery, would you have been willing to pay premiums for May, June, July, August, and however many more months until the insurance was approved?

[cbg]

I'm just jerking Tim's chain a little. He has my respect, even if not always my agreement.

[redflash777]

I think there is a misunderstanding here. Firstly, the need for surgery has nothing to do with it. I understand the active date only happening after all records have been received. What I am frustrated with is that for the past month, a doctor's office couldn't find her records and didn't notify anyone. I could have checked with them if I thought about it, but insurance takes a while for everything to go through so I wasn't worried about it. It was only after surgery that I found out they were just sitting on it and hadn't contacted anyone. If they had submitted records or notified the insurance company, we would have been active prior to surgery. I have a right to be frustrated about that because we should have been insured by now.

Thanks for those who contributed to the discussion!
Clint

[cbg]

Of course you have a right to be frustrated. No one is saying otherwise.

But the bottom line is that it is your responsibility, not your doctor's, to see that the insurance company has all the information they need. I completely understand that you were trying to be respectful of the fact that it takes time to pull things together, and I am appreciative of that fact. Not many people understand that. But nonetheless, what it comes down to is that you didn't follow up with the doctor.

[TIMMAAYY]

Originally Posted by cbg

I'm just jerking Tim's chain a little. He has my respect, even if not always my agreement.

I hate you all.

[moburkes]

No one is saying that you can't be frustrated. However, you failed to be an informed consumer. You took someone's word for it, that it would be retroactive, instead of verifying it for yourself.

The other person brought up a good point. I'm not sure what your premiums are, but, generally they're expensive. By the time you paid coverage from May to August, your premiums plus co-pays may have been in the range of the cost of surgery.

While, its not your fault your doctor dropped the ball, its not the insurance company's fault either.