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.