Dependants dropped without notification

[Daemonrai]

I live in Texas and have insurance through my employer (Aetna insurance). My wife and I have been covered for a few years and when our first child was born in May, we added her to the policy as well. Everything was fine until November, when I noticed one slightly larger paycheck. I figured out that I had been reimbursed for paid premiums, which has happened both ways once or twice over the last 2 years as coverages had been altered. A few days later, my wife discovered that her insurance was not being accepted anymore, so we called up the insurance company and they told us that they had not received some form that confirmed eligibility (which we did send in) so they removed my wife and daughter from the policy. The removal was retroactive, so after 4 months of coverage, they just dropped them without notifying us. For the month of Sept, they even sent bills to the doctors for what they had already paid. Can they just drop people without notification after having covered them, and do we have any options?

Thanks, Chris.

 

[cbg]

When you asked your employer about this, what did they say?

 

[Daemonrai]

So far, the only people we can get a hold of won't (or can't) tell us anything more than that they were dropped because they did not receive the dependant eligibility form. It wouldn't even have been a big issue had they notified us they were going to drop us, because then we could have made other arrangements for temporary coverage.

 

[cbg]

When you completed the form, did you send it directly to the insurance carrier, or did you submit it through your employer's HR office?

 

[Daemonrai]

We sent it to the Benefit Center. I'm not sure if that's HR or not, but I know it's not the insurance company. They're the ones that sent it out, and the ones we contact for pretty much every insurance related need, from health insurance to 401K stuff.

Thanks for the help. =)

 

[cbg]

That would be either the Benefits section of your HR department, or a third party administrator of your benefits. In either case, since you sent the form to them, ASSUMING THAT THEY RECEIVED IT, it is their responsibility. Did you mail it in? Hand deliver it? Did you send it certified? Do you, at this moment in time (we'll take this one step at a time) have positive knowledge that they received the form (as opposed to it having been lost in the mail, misdirected, etc.)? Is there ANY possibility that they never received it? (I'm not saying you have no recourse if they didn't, so don't panic yet. ) Just think very hard about it and give me a very literal answer. We can deal with it either way but we'd go about it differently so I need to know if you have ANY reason to think, no matter how remote, that the form might have gone astray.

BTW, just FYI, for Benefits people this is the very busiest time of the year and I can pretty much guarantee that it's not so much that you're being ignored as that they have three times as much to do as they can reasonably be expected to do, especially if this is a large employer. They will get to you. I've been there. I promise.

 

[Daemonrai]

There's certainly a chance that they didn't receive it. They're located a few states away so we mailed it. We've never had any trouble with them not receiving something before so we didn't send it certified. We figured they'd notify us, at the very least that they did not get it and were dropping my wife and daughter, and we would make other temporary arrangements.

And I know they're busy with the new year starting up (at which point both will be back on the insurance actually.) Since I didn't find out about the situation until late November, we weren't even to concerned with the situation. We had no more checkups for my daughter until February, so as long as no one got deathly ill in December, we knew we would be fine. It became an aggravation when they finally decided to somewhat notify us that we had not been insured for two months (by simply returning the money they had been taking out of my checks for that time period) and then to go as far as to send a bill to the doctor for a checkup they had already paid, which of course we got the call on today. And this after they verified the wife's eligibility two years (same process as this one, but no problems) and covering our daughter for 3 months.

 

[cbg]

Okay, that makes it a bit more difficult but not impossible. (Many years ago, before I was married, I briefly dated a postal worker who was very proud of the fact that the post office ONLY lost a million pieces of mail a year. He claimed that given the number of pieces of mail they handle, that was a very small percentage - I insisted that even so that was still A MILLION pieces of mail!)

Do you have anything that can verify, even indirectly, that you sent the form when you sent you did? A fax receipt, copy of a cover letter, anything like that?

 

[Daemonrai]

Unfortunately no. It was a couple of forms filled out and mailed back. I knew we couldn't prove that they got it, and I'm pretty sure that they didn't. More so, I was curious about the fact that their failure to not only notify us for 3 months, but also approve us each time we went to an appointment only to retroactively deny them later, prevented us from getting insurance elsewhere.

 

[cbg]

I just read your initial post again. I can understand what happened with your daughter - there are state laws regarding coverage for a newborn which may explain the delay in dropping her. I don't know offhand what Texas laws are on the matter, but in many states, they are required by law to cover a newborn for x amount of time (often through the inital hospitalization and sometimes 30 days) so if Texas has such a law, I can understand how it could have taken a while to catch up administratively.

However, the way I initially read your post, your wife was ALREADY covered on your policy. Was that not the case? Were you adding BOTH your wife and daughter at the time of the birth?

 

[Daemonrai]

The wife has been covered since we got married just over 2 years ago. That was the first time we got the eligibility verification and had no problems with it then. We called the day my daughter was born and got her set up on the insurance.

I don't know what's up with them. It just would have been nice for them to send a letter saying 'we're dropping your wife and child' so that we could have gotten them set up through the wife's job, or Cobra, or anything else instead of incurring 3 months worth of now uninsured visits.

 

[cbg]

While it would have been nice, it was not required by law - at least, not for your daughter. As far as they are concerned, if they did not receive the enrollment form she was never covered in the first place, so why should they send you something to say that? They provided the coverage that state law requires but beyond that, for all they knew you had other coverage for your daughter and didn't want or need theirs.

However, I am concerned about the dropping of your wife from the policy. Just to be certain, let me repeat back so that I am certain that I understand. Your wife WAS covered on YOUR policy BEFORE the birth of your daughter?

 

[Daemonrai]

100% correct on that. My wife was covered under my policy for about a year and a half prior to my daughter's birth and for 3 months after.

 

[cbg]

Then something is decidedly wrong, at least where your wife is concerned.

Since you are having trouble getting through to your benefits area, why don't you call the customer service number on the back of your ID card. Ask them specifically, and pin them down, why your wife's coverage was cancelled. Don't worry about your daughter for the moment. That's a different issue. Then come back and tell me what they say, and we'll go from there.

 

[Daemonrai]

I understand the rest of what you're saying. I guess because the wife was dropped, it didn't even cross my mind that my daughter may not have been officially on the policy in the first place. I'll update you after I get through to them.

Thanks so much for the help