whimseys2000
Junior Member
What is the name of your state? RI
I was covered under a family plan (BC/BS of MA) through my husband's employer for two years and when he left the company, we switched to Cobra (initially under BC/BS HMO, then moved to a self-pay with Anthem BC/BS.) There have been no gaps in coverage.
In March (approx.) of 2003, I began treatment for infertility. RI has a state mandate that requires infertility coverage be provided and covered 100%. Everything was fine (and everything was paid in full) until the company switched to a self-insured plan. Now Anthem BC/BS is denying my claims (for services that were previously covered under the HMO). Apparently the switch happened Septemer 1, 2003 althoough due to a mess up at Blue Cross, we did not receive our new cards until the 3rd week of September. Services were rendered Sept. 5. The only notification we received from the employer was back in July which stated that "coverage will change" but not explaining it will be a self-pay or getting a new summary of benefits. If I had known that, I would have known the state mandates were no longer applicable.
Anyway, I have appealed and BC says it was the employer's responsibility to tell me they were switching to a self-pay. Is this true? Do I have any recourse or am I now stuck paying these?
Did I make any sense?
TIA,
Cindy
I was covered under a family plan (BC/BS of MA) through my husband's employer for two years and when he left the company, we switched to Cobra (initially under BC/BS HMO, then moved to a self-pay with Anthem BC/BS.) There have been no gaps in coverage.
In March (approx.) of 2003, I began treatment for infertility. RI has a state mandate that requires infertility coverage be provided and covered 100%. Everything was fine (and everything was paid in full) until the company switched to a self-insured plan. Now Anthem BC/BS is denying my claims (for services that were previously covered under the HMO). Apparently the switch happened Septemer 1, 2003 althoough due to a mess up at Blue Cross, we did not receive our new cards until the 3rd week of September. Services were rendered Sept. 5. The only notification we received from the employer was back in July which stated that "coverage will change" but not explaining it will be a self-pay or getting a new summary of benefits. If I had known that, I would have known the state mandates were no longer applicable.
Anyway, I have appealed and BC says it was the employer's responsibility to tell me they were switching to a self-pay. Is this true? Do I have any recourse or am I now stuck paying these?
Did I make any sense?
TIA,
Cindy