SaulGoodman
New member
What is the name of your state? State: CO
I'm covered under a self-funded Plan through my employer and I incurred a medical service in June of this year that the Third Party Administrator denied as an exclusion. We switched to a new carrier on 11/01/17.
Although the coverage was effective on 11/01/17, I was never given a copy of the Plan Document to know this service wasn't covered. When I finally got a copy of it after my service was denied, I saw our human resources person never actually signed it until April 15th of 2018. Yet, it claims it was "retroactively" effective back to 11/01/17.
How can they retroactively make a document effective back to 11/01/17 when it wasn't legally executed (by signing it) until 04/15/18? And how was I supposed to know this service wouldn't be covered when I never got a copy of the Plan Document?
I'm covered under a self-funded Plan through my employer and I incurred a medical service in June of this year that the Third Party Administrator denied as an exclusion. We switched to a new carrier on 11/01/17.
Although the coverage was effective on 11/01/17, I was never given a copy of the Plan Document to know this service wasn't covered. When I finally got a copy of it after my service was denied, I saw our human resources person never actually signed it until April 15th of 2018. Yet, it claims it was "retroactively" effective back to 11/01/17.
How can they retroactively make a document effective back to 11/01/17 when it wasn't legally executed (by signing it) until 04/15/18? And how was I supposed to know this service wouldn't be covered when I never got a copy of the Plan Document?