Job refused to pay medical bills

[keti]

What is the name of your state? Florida

I was hired on Nov. 21 2002 and was told that my health benefits were to start 90 days later (February 20th 2003). I became ill and needed medical attention on Feb 23 2003 and i was not covered.
When I was billed and told my superior, she said that she forgot to enroll me in late January so that United Healthcare would record me in the month of February. She did it too late, and she said that the employer would ONLY pay part and not all of the bills incurred. They paid for 2. I was laid off in June 2003 from that job, and they now refuse to pay any of my bills creating a bad record in my already "messy" credit report.
I contacted them via mail and they replied " we will not pay for any further bills from that incident". All while I was supposed to have been covered. I don't know how I am going to pay for these bills nor how to get an attorney.

Thanks so much in advance for your comment

 

[cbg]

For the purpose of understanding all the details, please answer a couple of questions for me, and for the record, despite what these questions might sound like, I am NOT holding you responsible in any way for what happened. I am very, very familiar with the enrollment procedures of United Health Care and in some ways they are different from other insurance companies so bear with me. There's a reason for each question and it may not be the reason you think.

Did you at any time fill out an enrollment form? If so, when?

If you did not fill out an enrollment form, how did you notify your employer that you wanted the insurance? When?

Was the insurance 100% covered by your employer? If not, did they take your portion out of your paycheck?

How many employees (approximately) did this employer have?

Did you ever get the insurance? If so, effective what date? What date did the insurance cancel when you were laid off?

 

[keti]

reply to CBG

For the purpose of understanding all the details, please answer a couple of questions for me, and for the record, despite what these questions might sound like, I am NOT holding you responsible in any way for what happened. I am very, very familiar with the enrollment procedures of United Health Care and in some ways they are different from other insurance companies so bear with me. There's a reason for each question and it may not be the reason you think.

Did you at any time fill out an enrollment form? If so, when?

If you did not fill out an enrollment form, how did you notify your employer that you wanted the insurance? When?

Was the insurance 100% covered by your employer? If not, did they take your portion out of your paycheck?

How many employees (approximately) did this employer have?

Did you ever get the insurance? If so, effective what date? What date did the insurance cancel when you were laid off?

Yes I filled the form for United Healthcare, I was pressing them to let me fill the papers before February, and I did so 'during' Februaty 2003 when they were preparing the February premium to be paid.

I was told upon hiring that insurance was to take place 'within 90 days' of hire.

Insurance was indeed 100% covered, all i had to paywas a 15.00 co-pay fee at the time of Dr. services or 50.00 to the ER.

There were 10 people working in the office at that time.

Yes, I did get insurance which I used after March 1 2003, the effective date according to United Healthcare.


Thanks for your response cbg, much obliged

 

[cbg]

You misunderstood a couple of questions. When I asked whether the insurance was 100% covered, I meant, who is paying the premiums? Was your employer paying 100% of the cost or was there a portion of the premium being deducted from your paycheck?

I probably wasn't clear with this one. Are there ONLY ten employees in the entire company, or are there only 10 employees at your location but there are other locations with additional employees? If so, how many (approx.)?

You forgot to tell me when the coverage was cancelled. Was it the last day of June, or was it the last day of your employment?

 

[keti]

to CBG

Sorry , I thought that I was clear.

There were no deductions from my paycheck. Company paid full premiuns.

There were the owners of the company and fanily members that perhaps were part of the same covered group, I have no specifics on that. We were 10 people in our office, and come to think of it, the owner owns multi family real estate with leasing personel on site. Maybe they were under the same blanket? Can't say that I know that either. But I am trying to locate another worker who is more familiar with that, and has quit that position 3 months ago.

I was laid off almost mid June and was covered through June as a severance along with 2 weeks salary.

Thanks

 

[cbg]

Thanks.

Some of those questions were for the purpose of determining whether or not UHC has changed their enrollment procedures in the last few years. FYI, I was at one time an employee of UHC; I have also as an employer had UHC as the health care provider for my employees, so I know them from both inside and out. It sounds as if the procedures have NOT changed; however, if I'm wrong, it could change the answer - just be aware of that.

Whether your employer is responsible for your bills or not is going to hinge on one question; does the insurance contract that your employer had with UHC state that coverage for new employees will begin after 90 days of employment, or on the first of the month following 90 days of employment? When I was employed there, and later when I used them as my provider, the answer was first of the month following 90 days. While they would occasionally make exceptions, it was FAR more likely that any given new employee was going to be covered on the first of the month following whatever waiting period the company had established; in your case, 90 days. On the other hand, it was just as common for coverage to be termed on the last day of the month following the last day of employment, rather than on the last day of employment.

As an example, if the company had a 90 day waiting period and a new employee began employment on November 21 and was termed on June 13, their coverage would run from March 1 (first of the month following 90 days) and end on June 30 (last day of the month following termination). IF this is still the case, and IF this is how your contract reads, then your coverage was handled correctly and your employer has no liability for your bills.

If, on the other hand, your company's contract with UHC is one of the exceptions (or if UHC has changed their standard) and coverage is supposed to start on the 90th day after employment regardless, then I see no way for your employer to avoid liability.

What you need to do now is take a copy of the insurance plan's Summary Plan Description (SPD) to an attorney. (If you don't have a copy of the SPD, call your employer or UHC and ask for one.) You can call your local bar association for attorney referrals, or use the Find A Lawyer section on this site. Many will give free consultations. Ideally you want someone who specializes in employment law and ERISA; however, any good general practitioner will be able to read the SPD.

I can tell you that it was quite common when I was working for UHC for me to be asked several times a week about questions like yours, from employees who honestly believed they were supposed to have coverage on the last day of the waiting period and did not understand that it was the first of the month following the wait. However, I left UHC in 1998 and I left the company that had them as an insurer in 2000, so it's entirely possible that the standard has changed.

Good luck and let me know if you have any further questions.

 

[keti]

It all makes sense to me, and I will look into these issues further now that you have made me aware.

I want to thank you again for your effort in replying and I will let you know as to the outcome of my research.