Dropped from Insurance - 6 weeks before baby

Have you guys ever heard of being required to re-submit proof of marriage (or proof of children's birth) mid-way into an insurance policy when you haven't had a "new" qualifying life event?

My husband started with a company at the beginning of August 2009 and we both began insurance coverage without any hiccups (it was almost TOO easy). We'd been married nearly two years, so we didn't need to send any documentation on that, our effective date of coverage was immediate (his first day of hire), they assured me there were no pre-existing condition issues (they had proof of my coverage beforehand anyway), and they instantly approved all my pregnancy and diabetes-related treatments - from pods to insulin to high risk OB visits to even my (gasp) CGM SENSORS.

We re-enrolled for benefits for the new year in October. No problem. Our paperwork and plan selections were received and they continued to pay my claims well into December.

Then, a couple of days before Christmas, we got a letter from his employer saying I had been dropped from his plan due to "failure to provide adequate proof of eligibility" in the form of a marriage certificate and tax return. They are claiming that our marriage (in 2007?) was a qualifying life event that we did not send in requested documentation for and that they had sent a letter in early Nov. saying they would drop me if it wasn't received. We never received any such letter or any notice there was a problem. We could have remedied it immediately had we only known.

Furthermore, they claim that their cancellation of my coverage is back-dated to October 10, 2009 - the date we re-enrolled.

And to top that off, I'm a type 1 diabetic who is less than 6 weeks from giving birth to her first child. (I cried for two days straight.)

My husband quickly faxed in the marriage cert and tax return and my coverage was re-instated as of 12/22, but they are still claiming that from 10/10 to 12/22, I had no coverage and that they plan to retract all claims paid during that time. 73 days (a pretty little lapse there). Over 20 claims - endocrinologist, diabetes educator, OB/GYN, high risk OB, sensor order, pod order, insulin Rx's, test strip RX's, ophthalmologist, lab work, etc., etc. To the tune of between $5-10K. They've even gone so far as to refund the premiums paid toward my coverage on my husband's most recent paycheck. They kept paying claim after claim without so much as a whisper that there was a problem.

Yes, we are appealing it from every angle we can.

Here's the crazy part and the reason why I suggest ALL OF YOU check with your insurers. My parents, who are with a completely different insurer/employer, recently got a brief notice from their plan administrator that they had some documents needed for their own coverage file last week. My mom dug through some emails, made some phone calls, etc., and found out it was the same issue - proof of marriage (she and my dad were married in 1972 and have been with this employer and insurer since at least 1979). No new event - just the 'secret' that if she didn't happen to know they needed their marriage certificate by January 1, 2010 after 37 years of marriage that she would be dropped from my father's insurance.

WHAT. THE. HELL?

What is going on? Why are we covertly being required to re-submit proof of events without notice and then being dropped from coverage on these b.s. technicalities? Is this rescission at its worst? Does this happen every year? Is it because employer-sponsored group plans are looking to oust anyone they can b/c of new legislation, bad economy, etc? Is it a case of being one of the "too expensive customers" and just your run-of-the-mill diabetes-related insurance discrimination

Any suggestions for the appeal process? We've taken several steps already, but for multiple reasons, I won't go into detail just yet.

Views: 158

Tags: coverage, eligibility, insurance, rescission

Comment by Pauly on December 30, 2009 at 1:19am
Hey Melissa, Sorry for this huge life bump in the road for you.

I dont know if this will help but let me take a stab at it.

Doesn't your husbands company have a rep/adjuster? I worked for a city and they have a Rep I call when I have coverage problems. He represents the cities interest not the insurance companies, Well sort of most of the time . ha.... These reps can talk higher up the food chain than you can and these big insurance companies like to court these reps because they know they have great influence in getting them business. I have found them invaluable on a couple of issues and I know I was being heard at the division or corporate level.....

You probably have contacted your states insurance department. I would be currious if they have this right to do this two step with your coverage based on your post... This smells bad... If your husband got the insurance and you were married at the time I dont see what the beef here is....

Lastly a call to a good investigative reporter at your local TV station might do the trick too....These insurance companies dont want the bad press. Even if your story doesn't go on TV it can scare the hell out of these insurance companies when the press starts calling....
Comment by Joe Lenegan on December 30, 2009 at 3:09am
Thank god rescission is illegal here in NJ
Comment by Kelly Rawlings on December 30, 2009 at 7:45am
This is frightening. So glad your coverage has been reinstated for the birth, because that's the most important thing right now.

The insurer obviously got it wrong in trying to do this to you, 'cause you're a fighter. Just be very, very careful about what you write/publish online. My thoughts and prayers are with you.
Comment by Shannon on December 30, 2009 at 10:11am
I've never heard of anything like this before, but I have a funny feeling that your experience isn't the last. With the pending legislation, I think insurance companies are feeling panicked. What insurer are you dealing with? I can understand wanting proof of marriage (although why NOW?), but a tax return? What do they need your tax return for?

One thing I've found is that the standard policy for most insurers is to deny everything. They expect that most people won't fight any further, and they make billions of dollars that way.

What worries me so much about your situation is that they refunded the premiums paid. I think this fact makes a successful appeal unlikely. If they decide that you would be covered for that time (10/10 - 12/22), you'll have to send those premiums back again.

Is your husband's employer large or small? Has he spoken to his HR rep about any of this? I don't know what the insurance laws in Texas are like (are your parents also in Texas? Maybe there's been some law change lately that sparked this), but a consultation with an attorney might be a good idea, too. Just don't give up. That's what they're waiting for you to do.

I've been fighting with Aetna for seven months about a claim. They keep denying it and sending it to a different department, who then sends it to another. According to the terms of my policy, the claim should be paid. I'm not giving up until they pay it. If they think they can outlast me, they're very wrong.

I also like Pauly's suggestion about talking with the media. I know an AP Reporter who might be interested (or know someone who is) in a story like this . . .
Comment by Scott on December 30, 2009 at 10:24am
Mel,

I really hope this gets cleared up soon. Hang tough!

Scott
Comment by Tom Hinerman on December 30, 2009 at 10:28am
Melissa,
I just got off the phone with the state of Texas Insurance commission and they said they recommend you file a complaint with their office. They said they can't imagine any scenario in which this is legitimate. The website address to file it electronically is:
www.tdi.state.tx.us
or their telephone # is 1(800)252-3439 select option 1 for english and 0 to talk with an advocate.
Good luck
Comment by Joe_h on December 30, 2009 at 10:53am
very scary I know you'll kick their butts. any chance they can send you a copy of the letter - and wouldn't such a importnat notification letter be in registered mail (or is that asking for too much?). good luck and take care
Comment by Lee Ann on December 30, 2009 at 10:57am
That's unimaginable, Melissa! I've never heard of such a thing, and I can't think of how that can even be legal! I'm so sorry you're having to deal with this, especially *now*, but I hope that you're able to get it straightened out asap. Hopefully, the response about the TX Insurance Commission is going to lead you to a resolution. Please post an update when there are developments.
Comment by Michael Hoskins on December 30, 2009 at 11:23am
Melissa: I've had nightmares about this type of thing happening, and hope it works out for you both. Shannon makes some good points about not giving up, and particularly about checking first with the company HR person/dept and possibly consulting the media(AP) about it. That might shake things up. In reading this, not only did I gasp, but it motivated me to contact my wife's insurer with Anthem BCBS of Indiana and re-check that all is OK and documented and request another Cert. of Cred. Coverage to be safe. Keep pushing back, and let us know if there's any more we can all do.
Comment by Richard P Cosgrove on December 30, 2009 at 12:38pm
Melissa, what state do you live in? Have you appealed to the insurance commisioner at least that is what it is called in CT and we are the insurance state. I hope things work out for you.

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