Wife fired, HMO plan cancelled, referral to see specialist

[Yuke]

What is the name of your state? CA

My wife was terminated from her employer and I have a referral through her HMO to see a specialist. Do I see the specialist now or wait until we have signed up for COBRA?

 

[I AM ALWAYS LIABLE]

What is the name of your state? CA

My wife was terminated from her employer and I have a referral through her HMO to see a specialist. Do I see the specialist now or wait until we have signed up for COBRA?

My response:

Yuke, was your wife contributing to the coverage expense each month, or was this totally employer paid?

Have you looked at the policy booklet for conditions of termination, and whether coverage continues when there's ongoing treatment?

IAAL

 

[Yuke]

1. Yuke, was your wife contributing to the coverage expense each month, or was this totally employer paid?

she was contributing to the coverage


2. Have you looked at the policy booklet for conditions of termination, and whether coverage continues when there's ongoing treatment?

the policy booklet is silent on this matter. My wife called our HMO and they said it was "a Human resource issue" for her employer. My wife has told me that when her co-workers were terminated they lost health coverage immediately. However, there was no mention whether these co-workers had any ongoing treatment.

 

[I AM ALWAYS LIABLE]

My response:

Yuke, do you have, or do you know an attorney who has, access to Rutter Practice Guide - Insurance Litigation? There is a plethora of information, rules, laws, cases, codes that discuss your wife's situation.

You will want to read it all first-hand.

Good luck to you folks.

IAAL

 

[cbg]

It is exceedingly rare for coverage to be continued after the termination of an employee, because of on-going treatment. I'm not saying it never happens, but it is unusual enough that IF your wife's plan were one that provided that, it would say so in the plan booklet. If the plan is silent on the subject, you can pretty much take it to the bank that no such extended coverage exists.

If you sign up for COBRA, the COBRA coverage MUST be retroactive to the date of cancellation so that insurance coverage is on-going. It is legal for them to cancel the coverage until such time as they receive her signed COBRA form and her first payment, but at that time they MUST make it retroactive so that there is no break in coverage. There are no circumstances whatsoever in which they can start COBRA coverage on any other date except for the first date of cancellation.

So once she has signed up for COBRA, the specialist visit would be covered just like any other visit.