Termination of Health Insurance

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Holdtight
Holdtight Member Posts: 151
edited March 2014 in Colorectal Cancer #1
Hoping someone can give me a bit of advise as far as my legal rights are concerned. I've been working in the same job now for 2 years and was provided health insurance through my employer. I just found out my PET was good but I have to follow up with a Bone Scan to see if its side affects from the Neulasta in my bones. And I ache so bad. I went to schedule my PET Scan and was told my insurance was terminated. I called the insurance company and they told me they couldn't provide me with any information that I needed to talk to my employer. I asked him and he doesn't seem to want to give me a straight answer or cooperate. He did tell me he paid it yest morning but as of today I still do not have coverage. Anyone know what my rights are if he doesn't reenroll me. I AM IN THE MIDDLE OF TRYING TO GET TO REMISSION. IT IS JUST NOT RIGHT. Thanks.

Comments

  • abrub
    abrub Member Posts: 2,174 Member
    #2
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    Contact HR at your employer
    Follow up and find out what is going on. If your employer is self-insured, you may have to follow up with your department of insurance. Your rights vary depending on what state you are in.

    If your employer was late in paying the monthly premium, you might be reinstated with no break in coverage retro to termination date. However, if the employer was too late in paying, then the insurance company is within its rights to cancel coverage for everyone. You need to find out why you were terminated, and ask the insurer about individual coverage if you were termed due to lack of payment. If money is deducted from your paycheck to cover a portion or all of your insurance, you will have a legal battle, of your employer mis-using monies.

    Again - you need to find out the story, and don't accept that "they just paid". April 6 is beyond the limit if the payment was due on March 1. If payment was due on April 1, it should be okay.

    Good luck with this - insurance problems aren't pretty.

    I'm a broker and a benefits administrator as well as a cancer survivor, so I am familiar with these battles.
  • Sundanceh
    Sundanceh Member Posts: 4,392 Member
    #3
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    Uh, Oh
    Abrub has made some good points.

    What this sounds like is the old "You're costing me too much money, so we're done" game. It sounds like you may be working for a small business owner and not corporate America?

    Perhaps the premiums were too much, combined with the treatments etc.

    If you received no notification of your insurance being covered, I would think you have some rights. What I don't know is can a small business owner do this on his own? I've never heard of a corporation terminating someone's life insurance.

    I like Abrub's suggestions - she sounds schooled in this type of stuff. I could also add that you could call the Workforce Commission in your state to see if they can offer any assistance or be made aware of this development.

    Going back to your employer sounds like the first step - the hem hawing and back jawing probably means they are hiding something - the truth.

    You are right, that you should not have to deal with this when you're fighting your battle for health.

    It's good to see you, but sorry it is under these circumstances. I'm sorry you are going through this. I know you need insurance to do the PET or the cost would be just too much to bear.

    Another thought: You could contact the facility you are doing your PET out and ask to see a Social Worker or Financial Counselor - it's possible that you might qualify for help in doing the PET scan. I tried this recently, but I did not meet the guidelines, but I did ask about it - might be worth a try.

    -Craig
  • Holdtight
    Holdtight Member Posts: 151
    #4
    Options
    abrub said:

    Contact HR at your employer
    Follow up and find out what is going on. If your employer is self-insured, you may have to follow up with your department of insurance. Your rights vary depending on what state you are in.

    If your employer was late in paying the monthly premium, you might be reinstated with no break in coverage retro to termination date. However, if the employer was too late in paying, then the insurance company is within its rights to cancel coverage for everyone. You need to find out why you were terminated, and ask the insurer about individual coverage if you were termed due to lack of payment. If money is deducted from your paycheck to cover a portion or all of your insurance, you will have a legal battle, of your employer mis-using monies.

    Again - you need to find out the story, and don't accept that "they just paid". April 6 is beyond the limit if the payment was due on March 1. If payment was due on April 1, it should be okay.

    Good luck with this - insurance problems aren't pretty.

    I'm a broker and a benefits administrator as well as a cancer survivor, so I am familiar with these battles.

    Hi from New Jersey
    Thank you so much for such good advise. I hope you're feeling well. Are you now in remission? You sure look terrific with a great happy smile. Well he told me he has sixty days which means I might be reinsted with no break in coverage (he pays for my insurance)(I'm afraid of this preexisting condition contraversy right now) it is scaring me. I am due to see my Onc on Apr 14 and he wanted the bone scan done by then oh well looks like I need to wait on that one. How long does it usually take for an insurance company to post a payment. I thought since he paid yest. morning it should have kicked in by now. Trying to keep my scheduled bone scan for this Friday. Okay thanks again and have a good day! Hugs.
  • abrub
    abrub Member Posts: 2,174 Member
    #5
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    Holdtight said:

    Hi from New Jersey
    Thank you so much for such good advise. I hope you're feeling well. Are you now in remission? You sure look terrific with a great happy smile. Well he told me he has sixty days which means I might be reinsted with no break in coverage (he pays for my insurance)(I'm afraid of this preexisting condition contraversy right now) it is scaring me. I am due to see my Onc on Apr 14 and he wanted the bone scan done by then oh well looks like I need to wait on that one. How long does it usually take for an insurance company to post a payment. I thought since he paid yest. morning it should have kicked in by now. Trying to keep my scheduled bone scan for this Friday. Okay thanks again and have a good day! Hugs.

    Check on what he meant by "60 days"
    Group insurance cannot reject you for a pre-existing condition for which you've had coverage. You may be uninsured for up to 63 days before the pre-existing clause kicks in. Find out your termination date, and find out if your employer is reinstating you to your group policy; in which case there should be no break in coverage.

    If you are self-employed, I can help you get alternate group coverage in NJ. I'm not here trolling for clients, but if I can provide a service, I will.

    Yes, I'm currently in remission, tho that photo was taken right after I'd completed chemo, and was at a wedding with my family. I was happy - family together (rarity these days with grown kids) and a wonderful event - the wedding of a young woman I adore!

    I can send you my contact info in a private message, if you are interested, along with the website about the insurance we have in NJ.

    I'll help you straighten this out as best I can.
  • Holdtight
    Holdtight Member Posts: 151
    #6
    Options
    Sundanceh said:

    Uh, Oh
    Abrub has made some good points.

    What this sounds like is the old "You're costing me too much money, so we're done" game. It sounds like you may be working for a small business owner and not corporate America?

    Perhaps the premiums were too much, combined with the treatments etc.

    If you received no notification of your insurance being covered, I would think you have some rights. What I don't know is can a small business owner do this on his own? I've never heard of a corporation terminating someone's life insurance.

    I like Abrub's suggestions - she sounds schooled in this type of stuff. I could also add that you could call the Workforce Commission in your state to see if they can offer any assistance or be made aware of this development.

    Going back to your employer sounds like the first step - the hem hawing and back jawing probably means they are hiding something - the truth.

    You are right, that you should not have to deal with this when you're fighting your battle for health.

    It's good to see you, but sorry it is under these circumstances. I'm sorry you are going through this. I know you need insurance to do the PET or the cost would be just too much to bear.

    Another thought: You could contact the facility you are doing your PET out and ask to see a Social Worker or Financial Counselor - it's possible that you might qualify for help in doing the PET scan. I tried this recently, but I did not meet the guidelines, but I did ask about it - might be worth a try.

    -Craig

    HI!
    Thanks for your time and advise. I feel like **** it is draining me. My system can't handle these kinds of surprises right now. I just contacted the Workforce Commission and am waiting for them to respond. I am going to have a chat with my boss this afternoon. I'll keep you posted. Have a great day!
  • Holdtight
    Holdtight Member Posts: 151
    #7
    Options
    abrub said:

    Check on what he meant by "60 days"
    Group insurance cannot reject you for a pre-existing condition for which you've had coverage. You may be uninsured for up to 63 days before the pre-existing clause kicks in. Find out your termination date, and find out if your employer is reinstating you to your group policy; in which case there should be no break in coverage.

    If you are self-employed, I can help you get alternate group coverage in NJ. I'm not here trolling for clients, but if I can provide a service, I will.

    Yes, I'm currently in remission, tho that photo was taken right after I'd completed chemo, and was at a wedding with my family. I was happy - family together (rarity these days with grown kids) and a wonderful event - the wedding of a young woman I adore!

    I can send you my contact info in a private message, if you are interested, along with the website about the insurance we have in NJ.

    I'll help you straighten this out as best I can.

    Hi!
    Congratulations on being in remission. I just finished up Chemo March 13th. I was operated on in July for Colon CA and a liver ablation for the met to my liver. My after Chemo PET was clear (Smiles) but there is some haze of activity in my liver he wants to watch. I have to go for another MRI and PET in three months instead of 6 mos. I feel good about the outcome and I actually feel better through it all. I am finally getting more energy back. I mainly suffered from fatigue throughout my Chemo tx I slept like a bear this winter. LOL.

    Well, I spoke with my boss this afternoon and he informed me that he is letting his broker handle it and things should be okay by Friday. I have no idea why - would you know for what reason someone would go through a broker instead of handling it himself? he only said because he was a week late. But he did tell me he had 60 days. This is all new to me therefore any advise would be greatly appreciated.

    Thanks again for all your help.
  • abrub
    abrub Member Posts: 2,174 Member
    #8
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    Holdtight said:

    Hi!
    Congratulations on being in remission. I just finished up Chemo March 13th. I was operated on in July for Colon CA and a liver ablation for the met to my liver. My after Chemo PET was clear (Smiles) but there is some haze of activity in my liver he wants to watch. I have to go for another MRI and PET in three months instead of 6 mos. I feel good about the outcome and I actually feel better through it all. I am finally getting more energy back. I mainly suffered from fatigue throughout my Chemo tx I slept like a bear this winter. LOL.

    Well, I spoke with my boss this afternoon and he informed me that he is letting his broker handle it and things should be okay by Friday. I have no idea why - would you know for what reason someone would go through a broker instead of handling it himself? he only said because he was a week late. But he did tell me he had 60 days. This is all new to me therefore any advise would be greatly appreciated.

    Thanks again for all your help.

    brokers
    Sometimes we brokers can work with our insurance companies to let an occasional late payment slide. Clients are advised to go through brokers, and ideally, we will do whatever we can to help.

    However, you need to stay on top of this, because his 1 week late is actually 5 weeks late: by law he's allowed 30 days grace, so his March 1 grace period expired 3/30. I don't know where the 60 days comes in. Your coverage was terminated as of March 1, and the broker should have been advised of the pending cancellation of coverage about a week before the grace period ends. I am, and I warn my clients to arrange wire transfers or overnight payments.

    Hopefully, the broker will be able to work things out with the insurer. Keep me posted on what you learn on Friday. I'm very interested in how this turns out, both for you and from a professional perspective.

    Most insurance companies don't want to lose business, so there is a good likelihood that your coverage will be reinstated retroactive to March 1.
  • Holdtight
    Holdtight Member Posts: 151
    #9
    Options
    abrub said:

    brokers
    Sometimes we brokers can work with our insurance companies to let an occasional late payment slide. Clients are advised to go through brokers, and ideally, we will do whatever we can to help.

    However, you need to stay on top of this, because his 1 week late is actually 5 weeks late: by law he's allowed 30 days grace, so his March 1 grace period expired 3/30. I don't know where the 60 days comes in. Your coverage was terminated as of March 1, and the broker should have been advised of the pending cancellation of coverage about a week before the grace period ends. I am, and I warn my clients to arrange wire transfers or overnight payments.

    Hopefully, the broker will be able to work things out with the insurer. Keep me posted on what you learn on Friday. I'm very interested in how this turns out, both for you and from a professional perspective.

    Most insurance companies don't want to lose business, so there is a good likelihood that your coverage will be reinstated retroactive to March 1.

    Hi!
    Yaaa it was reinstated. Thanks you for your guidance. I will send you a message.
  • AnneCan
    AnneCan Member Posts: 3,673 Member
    #10
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    Holdtight said:

    Hi!
    Yaaa it was reinstated. Thanks you for your guidance. I will send you a message.

    Good job, Holdtight!
    Good job, Holdtight! Congratulations on having it re-instated.
  • msccolon
    msccolon Member Posts: 1,917 Member
    #11
    Options
    Holdtight said:

    Hi!
    Yaaa it was reinstated. Thanks you for your guidance. I will send you a message.

    Yey!!!
    Glad to hear it's been reinstated! I know you'll be breathing easier! Now go on and fight, fight, fight!
    mary

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