B
BL
Guest
Background for my questions:
Through the HIPAA law, I obtained health insurance with a group plan (thru a university alumni assn.) which is extremely expensive because I have a pre-existing condition and am now self-employed. This coverage became effective 9/1/00 (I had 18 mos. of creditable coverage) and I elected to pay premiums quarterly. However, when I received the initial paperwork, I had questions about discrepancies regarding the premium (i.e., one page said the premium would be 150% and another said it would be 250%, plus other concerns). It took a couple months to get everything straightened out (of course, the higher amount was correct--maybe even 300% by then), and I asked if the coverage could begin 9/1/00 instead of 7/1/00 as I had initially requested. Since I'd had no medical care and had submitted no claims during that time, this request was granted.
Another problem when I received the revised paperwork concerned the amount I still owed since I had sent checks to the company for various amounts as the process moved forward. Finally, about mid to late November, everything seemed to be settled (premium amount established and paid in full--very high, but I had no choice but pay it; correct paperwork received, signed and returned to the company).
Here's where the BIG problem begins: With all the months it had taken to get that far, I forgot that the next premium amount was due December 1, 2000. I did NOT receive a premium notice or billing statement/invoice from the company. On Dec. 18, I left on a three-week vacation to South America. When I returned Jan. 9 and picked up my mail at the P.O. on Jan. 10, I DID have an invoice for the premium from the company. However, the mailing date on the invoice's envelope was Dec. 14, and because I requested mail delivery stoppage Dec. 18, I did not receive it before I left. Therefore, I ALSO had received from the company a notice of cancellation of insurance dated Jan. 2.
The notice urged me to call to start the process of reinstatement of coverage, which I did first thing Jan. 11. I also asked to be faxed the reinstatement application (to avoid the mail delay that seems to occur from Omaha to Northern Virginia). I received the fax application that afternoon, completed and mailed it back--along with a check for the premium amount (as recommended by the customer service rep when I called)--the next morning, Jan. 12. I also sent an accompanying letter explained I had not received the letter until I returned (and sent a copy of the envelope with the Dec. 14 date on it). I have had no response from the company, and my check has yet to be cashed.
My questions are:
(1) Assuming it is unlikely they will reinstate my coverage since I'm sure they'd rather NOT have my business (because of my pre-existing cancer, altho I'm currently extremely healthy, and even charging me nearly $9,000 a year for it), do I have any recourse to get them to do so since I don't believe the failure to pay the premium on time is entirely my fault since they billed me for it so late and it wasn't received until I was out of the country?
(2) If there's no way to get them to reinstate my coverage, have I unwittingly created a situation that means I won't be ABLE to get health insurance from any company? My COBRA coverage ended 7/1/00 and I had this group insurance 9/1-12/1/00. So it hasn't lapsed (ever) for more than 62 days, BUT it was cancelled for failure to pay the premium. As I read all the HIPAA requirements for coverage, one refers to cancellation as a problem in getting coverage under it--right?
I'm sorry for the length, but as you can see, I'm extremely concerned that I'm going to end up without any health insurance and/or be hit with exclusions for my existing condition for a long time or forever and/or be hit with a cost of perhaps over $10,000 a year for coverage. I am also concerned because of the HIPAA 62-day lapse provision, which would be around Feb. 2, but am not even sure I can still get coverage under HIPAA anyway.
I understood the HIPAA law very well initially, but now, with the cancellation, etc., I'm not sure what it all means for me. Any advice, legal or otherwise, that I can get concerning my situation would be very much appreciated.
Thanks! Barbara
Through the HIPAA law, I obtained health insurance with a group plan (thru a university alumni assn.) which is extremely expensive because I have a pre-existing condition and am now self-employed. This coverage became effective 9/1/00 (I had 18 mos. of creditable coverage) and I elected to pay premiums quarterly. However, when I received the initial paperwork, I had questions about discrepancies regarding the premium (i.e., one page said the premium would be 150% and another said it would be 250%, plus other concerns). It took a couple months to get everything straightened out (of course, the higher amount was correct--maybe even 300% by then), and I asked if the coverage could begin 9/1/00 instead of 7/1/00 as I had initially requested. Since I'd had no medical care and had submitted no claims during that time, this request was granted.
Another problem when I received the revised paperwork concerned the amount I still owed since I had sent checks to the company for various amounts as the process moved forward. Finally, about mid to late November, everything seemed to be settled (premium amount established and paid in full--very high, but I had no choice but pay it; correct paperwork received, signed and returned to the company).
Here's where the BIG problem begins: With all the months it had taken to get that far, I forgot that the next premium amount was due December 1, 2000. I did NOT receive a premium notice or billing statement/invoice from the company. On Dec. 18, I left on a three-week vacation to South America. When I returned Jan. 9 and picked up my mail at the P.O. on Jan. 10, I DID have an invoice for the premium from the company. However, the mailing date on the invoice's envelope was Dec. 14, and because I requested mail delivery stoppage Dec. 18, I did not receive it before I left. Therefore, I ALSO had received from the company a notice of cancellation of insurance dated Jan. 2.
The notice urged me to call to start the process of reinstatement of coverage, which I did first thing Jan. 11. I also asked to be faxed the reinstatement application (to avoid the mail delay that seems to occur from Omaha to Northern Virginia). I received the fax application that afternoon, completed and mailed it back--along with a check for the premium amount (as recommended by the customer service rep when I called)--the next morning, Jan. 12. I also sent an accompanying letter explained I had not received the letter until I returned (and sent a copy of the envelope with the Dec. 14 date on it). I have had no response from the company, and my check has yet to be cashed.
My questions are:
(1) Assuming it is unlikely they will reinstate my coverage since I'm sure they'd rather NOT have my business (because of my pre-existing cancer, altho I'm currently extremely healthy, and even charging me nearly $9,000 a year for it), do I have any recourse to get them to do so since I don't believe the failure to pay the premium on time is entirely my fault since they billed me for it so late and it wasn't received until I was out of the country?
(2) If there's no way to get them to reinstate my coverage, have I unwittingly created a situation that means I won't be ABLE to get health insurance from any company? My COBRA coverage ended 7/1/00 and I had this group insurance 9/1-12/1/00. So it hasn't lapsed (ever) for more than 62 days, BUT it was cancelled for failure to pay the premium. As I read all the HIPAA requirements for coverage, one refers to cancellation as a problem in getting coverage under it--right?
I'm sorry for the length, but as you can see, I'm extremely concerned that I'm going to end up without any health insurance and/or be hit with exclusions for my existing condition for a long time or forever and/or be hit with a cost of perhaps over $10,000 a year for coverage. I am also concerned because of the HIPAA 62-day lapse provision, which would be around Feb. 2, but am not even sure I can still get coverage under HIPAA anyway.
I understood the HIPAA law very well initially, but now, with the cancellation, etc., I'm not sure what it all means for me. Any advice, legal or otherwise, that I can get concerning my situation would be very much appreciated.
Thanks! Barbara