Health benefits terminated w/o notification bfr fired (bit long)

[tracker2208]

What is the name of your state? NV
Sorry for the long post. My actual questions are in bold.

On April 10th I was fired (not for gross misconduct or anything like that). My last job I kept my health insurance for more than 30 days after I left, so when I felt ill May 1st I called my insurance company (Anthem Blue Cross Blue Shield) to see if I was still covered. They told me they could say I was covered for that day I called but couldn't say after. I was hospitalized until released May 3rd. Each day in the hospital I call Anthem and they told me I was covered for the day I called. Around June 15th or so I started recieving bills saying that Anthem denied my claim. When I called Anthem told me the group policy was terminated March 31st, and only told me my previous employer choose not to renew when the contract was up. They wouldn't respond when I asked why they confirmed coverage May 1st-3rd when I called, they would only repeat my coverage ended March 31. Originally my bills totaled over $22,000, but the hospital gave me some kind of "uninsured discount" and now stands at over $11,000. If I would have known I didn't have insurance I would have gone to a local Indian Health Services location (I'm an enrolled member of an indian tribe and would have recieved free or reduced cost care).

My first question is about Anthem. Can they tell me I'm covered then say I'm not when they get the bills? In addition to calling them the emergency room gave me a printout of my insurance information that showed I was covered, but at the bottom it states that it is not a gaurentee of payment, depending on contracts and so forth. I'm not too hopeful that they are liable for much in my case. If it make a difference I think they dropped us because out of 10 employees on had a history of cancer and one had a spouse diagnosed with cancer (and going through treatment for the past year), but I'm not sure.

The other question is about my former employer. Full time employees recieved health insurance for free, and you had to pay for any dependance/spouse. I've seen on posters they have in every business break room (the ones showing employees rights) that an employer must give 10 days notice before reducing compensation, which I assume health benefits are a form of compensation. I also found Nevada Revised Statute 608.1577 (http://www.leg.state.nv.us/NRS/NRS-608.html#NRS608Sec1577), which states they must give 15 days notice before change or termination of beneifits. Do you think if they do not cooperate the courts would compell them to cover my medical expenses? I know this question is highly subjective, but would this be a type of case an attourney would take on a contingency basis (paid when/if wins).

Another wrinkle is the business entity is an LLC. They filed thier annual list of officers late. I need to double check with the Secutary of State, but it appears the list was due March 31st, the SOS revoked thier charter on April 5th, then they filed and were reinstated April 13th. I'm thinking that because the charter was revoked when I was fired the members/owners lost the liability protections an LLC affords them. Am I right about this? One of the members may be a huge fortune 500 company (or some kind of capitol group they control, I'm looking into that right now). I don't think this concerns me much but I found out my former employer didn't even tell the current employees until 3 or 4 weeks ago. Not only that but they were deduction premiums from paychecks for those that paid for spouses and dependants for coverage that didn't exist the whole time. I know one person raised hell and got his money back eventually, but another person I know is too afraid to loose her job to raise an issue (she's the type who needs the money back the most).

I'm sending a certified letter requesting payment for medical expenses tomorrow. I'd rather not go through an attorney but will if they are non responsive. I would like to hear opinions from members of this forum though.What is the name of your state?

 

[cbg]

Question 1: It's not necessarily Anthem's fault. It's not uncommon for policies to be cancelled retroactively, both on an individual and group basis. Without going into all the possible reasons why, 25 years of experience with managing group health insurance policies from both the employer and insurance carrier side of the desk tells me it is not in the least impossible that the information Anthem gave you was correct at the time they gave it to you, and that the policy was cancelled after the fact. Retroactive cancellations are much more common than many people realize. Anthem does not have the legal right to drop group coverage because of claims, but the employer does have the legal right to drop the policy if it gets to be too expensive (and on a 10-person group, claims like that would make the cost of the coverage quite expensive).

Question 2: You can try it, but I wouldn't be terribly optimistic. You were no longer an employee and had no legal expectation of having the coverage continued (just because your former employer continued coverage for 30 days doesn't obligate another employer to do so) and with only 10 employees COBRA does not apply. I very much doubt that the intent of the law was to require your employer to continue coverage after you were no longer employed. I seriously doubt that you could convince an attorney to take this case on contingency since I do not believe you have a claim.

Question 3: Beyond my experience. You'll have to get an answer from someone else. But if you are thinking that if correct you can sue the owners/members for reimbursement of your medical expenses, again, I doubt you have a claim. You had no legal expectation of your coverage to be continued afterthe last day of your employment unless you had a contract that guaranteed it, a state law that requires your employer to continue your coverage, or the insurance policy provided for it.

 

[tracker2208]

As far as question 1 goes, what if it definately wasn't a retroactive cancelation? Right now all I have are rumors. The way I understand it is they sent Anthem a check towards the end of March and Anthem sent it back the same day they recieved it refusing to cover them becuase of the ongoing cancer treatment for the VP's spouse. I really think this is a case of the left hand not knowing what the right hand was doing when I called to verify instead of a retroactive cancelation. The guy who handled that type of thing just recently quit, and I don't think he'll mind sharing with me what really happened. I'm still not hopeful on this.

My whole point with the second question is as I understand it they acted not just negligently but also unlawfully when they choose to withhold the fact that we didn't have health insurance anymore. My whole situation is a direct result of that. If they would have mentioned anything during the month of April to anyone I would have found out and none of this would have happened. I bet I could prove a reasonable expectation of a 30 day contuance of coverage by what other people were told when they were let go (when they had an HR person that knew what she was doing). I'm glad you brought that up so I can prepare for that. I know it sounds like I want to solicit opinions that I want to hear. Even if you are right and I have no reasonable cliam and no lawyer would take my case on contingecny I would still file action myself. It would be worth the legal fees just to grill these people under oath. I could also make thier lives difficult too. These people have an incredibly difficult time following simple industry specific regulations and are on thin ice with the State of Nevada (other states too) to begin with (I don't want to say which industry becuase I don't want to get too specific just yet until I get the ball rolling).

As far as COBRA goes I'm pretty sure we averaged more than 20 employees in the previous 12 months. Even if thats not the case I'm pretty sure there is a similar program run by the State of Nevada if the company averaged less than 20 employees. But I think they weasel out of both sets of regulation because there is no longer a group plan.

Bottom line is if I have to I'm going to pursue this no matter what I hear on this forum. I have too much contempt for this company (actually just the VP, I would be estatic if he was fired over this even if I don't get anything). I do think however that its very benificial for me to see specifically why an attorney might think that my case has no merit. Thank you for your response. And I welcome any more criticisms anyone might have.

 

[cbg]

Up to you. No skin off my nose.