A Tale of SURGERY & Two Insurance Plans. . .

[ProBono20005]

What is the name of your state?I have a potential legal dispute with one (maybe two) insurance plans in regards to surgery I recently had. I'll try to keep it as simple as possible but it's a tangled mess. I had one Health insurance plan (from my last job) since last October 2004 which I kept through COBRA. In Feb I started seeing a Surgeon to get his opinion on my condition and in the end, decided that I would go ahead with the surgery I needed. It was scheduled and done at the end of May 2005. Up to that point, the only insurance information I provided any doctor was from the COBRA Plan. Maybe a week, after my surgery, I found out (when I made a routine call to my pharmacy) that my insurance was EXPIRED!

Through MANY calls (and stress I didn't need when recovering from major surgery) I found out that the Plan I had through COBRA was Cancelled (even though I was paid through June) because I was enrolled in my current employers health plan. I enrolled in current employers plan in February 2005. I had NO IDEA enrolling in my current employers plan could jeopardize my enrollment in the COBRA Plan, especially since a close friend said she had both COBRA and her job's health plan and it wasn't presenting a problem. Again through MANY phone calls, I found out that APPARENTLY, the surgery was approved through my current job's health insurance and NOT through the COBRA plan as I thought. How they got my current jobs health insurnance info, is a mystery to me, other than Both Plans in some way share the same database (I think both plans are in some way involved with QualCare).

I am more than happy to let sleeping dogs lie, so to speak. And let me stress that I was NOT trying to rip anybody off or bill twice for any medical service. And the only money I've gotten back from the COBRA Plan was a check I sent at the end of May to cover the Premiums for July, August and September.

My QUESTION is, after having the surgery approved and getting it done, could one or both plans decide to REVOKE some or all of the coverage they provided for the surgery? leaving ME stuck with the BILL? And if so, what kind of recourse do I have & should I get an attorney?

Thank you for ANY help you can provide!

W G , New Jersey

PS-So far, I have only received 1 bill from the surgery, which I have referred back to my current insurance for resubmission.

[cbg]

Your current insurance CANNOT be revoked unless you yourself make the decision to drop it or the entire plan is cancelled by your employer (not just for you but for everyone). There is NO legal way your insurance carrier can opt to drop you from the plan without the knowledge and permission of both you and your employer; they know this and it would not even occur to them to try.

You became ineligible for COBRA under the law as soon as you signed up for the current coverage. That information should have been in the inital paperwork you received. There are occasional exceptions to that; it may be that your friend fell under one of the exceptions or it's possible that your friend's employe simply chose not to invoke it.

[ProBono20005]

Just wanted to say thanks for the reply & info. I appreciate your help!

Best Regards,

W G