paying for insurance and employer not getting it

[gjbb4]

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


Let's just say...IF.....(for legal reasons )

If my husband is having money taken out of his paycheck for medical/dental coverage and his employer has not made paid the insurance company ...for almost a month is there anything we can do? He says he has taken care of it but....We have no coverage medical/dental/pharmacy still
This is not the first time this has occured (has done this a few times before) Plus my husband has been paid late several times. He is to be paid on the 15th and last day of the month and several times it has been a week late. Hence we get late in paying bills which looks bad for us.


We have two children who seem to always need to go to the doctor and need medicines for allergies.

Sorry never posted before hope I played by the rules....

 

[cbg]

What, if any, recourse you have depends upon whether he ultimately makes the payment or not. Making payments late is not the same thing, legally, as not making them at all.

 

[gjbb4]

so am I responsible for the Dr.s visits that we went to before we knew that we didn't have coverage? The dr.s offices had called to tell me that we no longer had coverage with a particular co. and asked if we had changed insurance co. (that 's how we found out). Do we send the bill to him and tell him he has to pay it.
a lapse in coverage seems more than paying late to me....

 

[cbg]

Believe me, I've been through this. Both from the insurance carrier side and as an employer whose accounting department screwed up. When I worked for the insurance carrier, I was the one who took the phone calls about cancelled coverage and at one time when I was working in Benefits, I turned in the bill for the insurance policy to Accounting on time, but they LOST it.

If your employer makes the payments, even late, there is EVERY reason to believe that the coverage will be reinstated, retroactively, so that there is no gap in coverage. The company I worked for would allow 3 terminations for non-payment in a rolling 12 month period. Other companies might have different rules, but frankly no carrier wants to permanently cancel coverage for non-payment; it's much less trouble administratively to reinstate it.

Here's how it works, more or less. Let's say your company's premiums are due on July 1. If they haven't been paid by July 15 or so, they'll send out a reminder. If they STILL haven't been paid by August 1, then the coverage will be cancelled retroactively to July 1, since the last day they were paid for was June 30. However, if the payment comes in on August 10, they'll reinstate the coverage and it'll be as if it were never gone. You might have to ask the doctor to resubmit a couple of bills but the coverage will still be there.

The above is illustrative; there might be variables. It is, however, fairly representative of how insurance carriers work with group health plans.

If the employer does not make the payments at all or if the insurance carrier will not accept them, then the employer owes you the premiums you paid back. Legally, you, not the employer, are responsible for any doctor bills. It is not impossible that a letter from a lawyer might not shake some payments loose from the employer, but LEGALLY it is you who received the services; therefore it is you that owes the payment.

 

[moburkes]

Since you also know this is a problem, you could call the 800# on the back of your insurance card to see if it is active prior to the visit. I realize what cbg just said, but you do still have that option. If you call, and they say coverage is not active, then you decide if you can afford to pay out of pocket. In the meantime hubby needs to start looking for a job elsewhere since this employer is having difficulty managing his money.

 

[gjbb4]

OP here

agghhhh...Ok now that I got that out...


Thanks for the info....it's just frustrating from the wife point of view... I feel useless


As for hubby looking for another job...we are working on that (got any good IT jobs for him )

Thanks again for the info

 

[momm2500]

you can also contact the DOL-department of labor-and see what they say. sometimes when they get to the employer......then the bills get paid on time.

 

[cbg]

The US DOL would be a good option if the policy is not reinstated and the employer does not return the premiums. It might even be a resource if the policy is not reinstated and the employee is left with bills to pay.

But they've got too much on their plate to get excited about an employer not paying their bills on time. If the policy is reinstated, the DOL is going to say, Yeah, so what? (BTDT)

 

[gjbb4]

UPDATE!!! OP here

thanks for all your advice...

My husband's employer told my husband that he was going to be closing his doors...basically letting my husband go. He said he didn't realize how much work was involved (WHAT?!) anyway...he is trying very hard to find a job for my husband. Now the only issue we are having is that the guy he found to "take" my husband wants my hubby to sign..oh what's it called...a work stop contract....which is very rare in my hubby's line of work DOD stuff...we are in the NOVA/DC area that's more then 50% of jobs around here.

It's always something, I know I know I should be happy he has a job (or should I say) someplace to "TAKE" him. Sorry I'm just chuckling to my self...he sounds like a stray animal....Poor guy

Thanks again


sorry, it's called a no compete contract..not work stop contract