His company lied, and it may cost us insurance. Are they liable?

[UAHomebirth]

What is the name of your state (only U.S. law)? California

Long story as short as I can make it:

I am in a high-risk pregnancy, and we were going to move about 350 miles to be nearer to family for the third trimester and delivery. The risk level in my specific case includes elevated risk of maternal death. This move isn't a pleasure move. It's one backed by our current doctor. My fiance's employer agreed four weeks ago to transfer him. The agreed-upon last date of work is August 4th.

Fast forward to yesterday. After asking repeatedly about the transfer, which of two stores, pay, etc., and being told, "We'll let you know, we'll let you know", they finally tell him he has to apply at those stores directly. They withheld this information until two weeks before we're moving. There are no openings at those stores now. Our notice is in here, and this apartment has been re-rented. We're in a lease with the new complex to start the 6th. Staying here isn't an option if we want a roof.

The big problem we have is we are in a position now where we have to move, and because of information intentionally withheld by more than one manager, my fiance now won't have a job with this company when we move (his ex-employer offered him a position, knowing what's going on, but insurance isn't included for 90 days), meaning no insurance for me to see a doctor during the high risk time of pregnancy. Medi-Cal counted his income as known father and I didn't qualify. If he gets Cobra, the cost will be more than we can afford.

Since his current employer knew the risks, were seemingly supportive of this move, and then lied by omission about what needed to be done to get another job (there is no actual transfer process, only the employee applying at other locations - until today, they led him to believe they were the ones responsible for his transfer), do they face any liability? What makes me think so is their blatant dishonesty that was maintained by three managers. A single manager could be explained as needing more training, but all three reeks of conspiracy (they are now short three people for his position, which happened after his letter of intent to transfer four weeks ago) to keep him there so they're not four short.

I guess what we really need to know is their responsibility in this, ad what expectation we should have of them being honest and not withholding life-altering information.

 

[ecmst12]

Cobra will very likely cost less then your medical care without insurance.

I don't think you have any recourse against his employer.

 

[cbg]

Tell me something.

Suppose his company had NO stores in the area you are moving to. Would you still be making the move?

 

[UAHomebirth]

Not to that area, no. But they do, and his current location told him THEY WOULD TRANSFER HIM, which turned out to be a LIE, and based on this lie, we've given our notice at our current place and are signed to take the keys on a new place in two weeks. If they would have told him weeks ago when the "transfer" was approved that he actually had to apply directly to the other locations, rather than told him they were "working on it," before we gave notice to our apartment managers here, he would have applied and found out whether there were any internal openings before we gave our notice and contracted somewhere else. If they had no openings, we wouldn't have given notice at this apartment complex just yet, but rather have waited until there were. Now we can't stay here, and even if our current apartment hadn't been re-rented to someone else for a week after we leave, our rent money for next month and then some has already been paid to the new apartment managers to hold the new place for us, so we couldn't pay for here now.

 

[UAHomebirth]

ecm, I have a pre-existing medical condition. They're estimating Cobra to cost upwards of $2k. A private plan will cost about $1500 for the ONE plan that will take me and has maternity coverage. The one plan there that will take me without maternity coverage is still over $1k. On a household income of $3k, this is simply not affordable if we want to pay rent and eat and take care of this thing called taxes. Through his employer, it's $176 per month. Medi-Cal said our household income is too high for me to qualify for anything and that we have enough coming in to be able to afford private insurance. Let's just ignore that this is the Bay Area and cheap housing is the dangerous areas is still in the four figures.

 

[Beth3]

What you really want to know is whether your fiance can sue his employer for detrimental reliance. That will be completely fact-specific and something he will need to discuss with an attorney. Even if he does have a valid cause of action, it will take a very long time to either settle the claim or try it in court. Pursuing legal action will not help you out in the short-term.

One possiblity to consider if this is an option is that your fiance continue to work in his current job at his present store location and you move to be with your family until the baby is born. Less than ideal of course but at least he has a job and the two of you and the baby have affordable insurance.

If that's not an option, then the only other short-term option I can see is for you to take the COBRA coverage his employer is offering.

 

[UAHomebirth]

His medical coverage is specific to this part of the state. For the move, we're talking 350 miles, not a distance that's drivable though long. 700 miles round trip just isn't do-able. The problem with either or both of us staying is where the hell we would live. We spend next month's rent and then some on the new apartment. If we gave 30 days notice right now that we're not taking it after all, we're still on the hook most of a month's rent. How do we pay rent in THIS area?

I know that any lawsuit would take time, that the courts don't work overnight. We're hoping that, if something could be actionable, that simply letting his employer know would cause them to get into gear and rectify this mess. They're not hurting for money. They're one of the few companies that's seen profit grow faster (and during a recession, no less!) that at any other time in the company's history. "Detrimental reliance" is the perfect phrase for what this is. We trusted them to tell us the truth, they lied by withholding information and telling him they'd tell him when they knew something and this application system they knew all along, and it's costing us a lot of money, and either our home or our medical coverage, during a dangerous time for me to have no coverage.

The Cobra coverage would be almost 2/3 (by his employer's estimate) of our entire household pre-tax income. Paying for Cobra would put us literally on the street. Last I know of, hospitals don't release newborns to go live on the street. Not everyone has family with homes large enough to accommodate any more people either, nor do all people have family who own homes who can go against the laws pertaining to how many people can live in a rental unit.

Since we're not married, how can the state take his income against me when I applied for Medi-Cal? It's not ideal, I hate the idea, but we've both paid into the system our entire adult lives (minus the time I've been laid off), only for me to not qualify because he works! Even if I could get it a few months until he can get insurance through the other company that's offered him a job, that would be fine, but they told me I don't qualify at all. Isn't temporary use exactly how the system is supposed to be used? And I'm taking a very specific three-month period of time, not "maybe three months, depends on when he gets a job," because he has an offer! This this three months is the last of this pregnancy, so are the most important. Why the hell have we paid taxes if, when we genuinely need help and the doctor I currently have is afraid I won't make it through delivery, I don't qualify for ANYTHING? If he quit working altogether and didn't contribute any taxes, then I'd qualify for Medi-Cal. There's more of an incentive to NOT work in this broke state. This is so f*cked up!!

 

[Beth3]

Unfortunately, I don't have a solution for you. If your fiance thinks that the threat of legal action might induce the employer to consider following through on their initial promise, then he should speak with an attorney right away. There's no guarantee this will be successful though.

 

[ecmst12]

Is it possible you'd qualify for the Cobra subsidy from the stimulus plan?

 

[commentator]

commentator

Is it really the system that's messed up when several people on this forum tried to tell someone very recently in a similar position that Medi-Cal was not in the business of making your personal arrangements work for you. Even though these personal arrangements were supported by your doctor,they're still personal, not related to the fiscal success of the employer or tied in with the requirements of the Medi-Cal system.

You want your boyfriend's income to not be counted for Medi-Cal, but you wanted him to be able to get, keep and carry insurance coverage for you through his job. And the employer did not have your best interests at heart, rather the interests of the company, so that a very careful check of the situation might have been in order before you burned any bridges at the present situation where he did have a job.

Retail stores very rarely transfer from store to store, just in general. I wouldn't have believed they were so willing and that it was a done deal unless they had had your boyfriend signing up on the new store's paperwork, sending his personnel files down there. No way he can stay with friends, hold onto old position right now while you move to new area?

You'll just have to go on with your medical care, accumulating huge bills, and eventually going back to the Medi-Cal system when your bills become eligible for a "spend down" which means they far exceed your ability to pay them on your present income. Do not pay off a single medical bill right now. Use your available monies to live on. But eventually the medical bills will accumulate to the point that you will be able, even with his income to get assistance paying them.

 

[UAHomebirth]

ec, the cost of Cobra is almost $2,000 for continued coverage. We don't have this kind of money available.

Commentator, my fiance and I want him to be able to keep coverage OR for me to qualify for Medi-Cal. In this state, it's easy to have most of that $2,282-limit be just the cost of rent on a modest apartment in an area here. The cut-off for Medi-Cal is twice the poverty limit, which is set at the national level. We've both paid into this system almost every month of our adult lives, and when it's needed so I don't die (I'm that high of risk that with a doctor's care, I've been given a 25%-chance), we don't qualify. Our household income is not that much greater than $2,282, but we're comfortable by not getting into debt.

It would be "nice" to be able to accumulate debt for this, but you have insurance, right? How do you suggest someone without it get a doctor to let her have office visits without insurance or paying up front? Visits with a perinatologist are hundreds each. So letting bills accumulate just isn't going to work since there's no way to accumulate them. No law says a doctor MUST accept a patient in a non-emergency setting.

He has e-mails from his employer confirming that they said they were "working on the transfer", and then was told that they don't actually do it. He has proof of being misled. And no, staying with a friend while I move isn't going to do it. His insurance is specific to the area. If I move, there won't be a doctor there taking insurance specific to this area. We don't have any friends here with room anyway. There are legal limits to how many people can live in a rented dwelling. A couple of them are already over that legal limit. None of them own. We've already thought about this.

 

[ecmst12]

You said that already. I was asking if you'd looked into the 65% government subsidy for Cobra if you lose your job at no fault of your own. I'm not sure if this situation would qualify, but you should look into it.

 

[commentator]

commentator

There are many ways people who are uninsured in this scrappy health care system we have today get medical care without medical insurance. In some cases they work through the doctor they had when they lost their coverage, negotiating for care to continue until the pregnancy is over and they can work out some means of payment. Clinics for the uninsured usually have referral lists of specialists who will be willing to work with "at high risk" patients under these circumstances. Local health departments in the area you are going to be living can offer suggestions.

But ranting about a system that has not changed a bit, is sketchy, but is doing what it is set up to do, simply because it has not worked out for you is classic of what people tend to do in this country. We pontificate about how the needy aren't truly needy, they should be like us, employed and insured....until something happens and we are no longer in that lucky category.

Right now you are negating all suggestions, convinced that there should be someone you can legally punish for "fairness" issues, but something will work out for you. It will.

 

[CourtClerk]

Since we're not married, how can the state take his income against me when I applied for Medi-Cal? It's not ideal, I hate the idea, but we've both paid into the system our entire adult lives (minus the time I've been laid off), only for me to not qualify because he works!

Because you would like me to pay for the medical care for you and your baby and I didn't get the joy of making it (if there was any joy in it). Therefore, the State of California and the rest of us who had nothing to do with making your baby would like the 2 people who DID make the baby to be responsible for the medical care for you and your baby, which includes your boyfriend. He's around, you guys are shacking up, then you two make provisions for your offspring. Rest assured, I've paid into the system since I was 15 1/2 years old. High risk pregnancy and all, I have not been able to, nor will I probably ever see a dime of that money come back to me. Never took a dime of public funds, except my paycheck.

As said, it's not an ideal situation but you go move to the new apartment closer to your family and your boyfriend needs to borrow a sofa and stay at his job until he can find you guys somewhere to live somewhere. Suing your employer right now (or threatening to sue) probably isn't so smart.

 

[ecmst12]

Where did you get the information that you don't qualify for Medi-Cal at all? That isn't the impression that I'm getting from the web site. Pregnant women can have higher income limits and still qualify, and if your income is STILL too high then you should be able to get a cost-sharing program so that you can have affordable coverage.

Is There A Special Program For Children and Pregnant Women?
Yes. Pregnant women and children may have more income and property than other people and still qualify for no-cost Medi-Cal services. The income guidelines are different for children under age 1, children 1 to 6, and children 6 to 19. Your family property, such as savings accounts or cars, is not used to determine eligibility if monthly income falls within certain limits.