I am desperate for some help and am not sure who to call for help.  My husbands employer made a paperwork error that caused our insurance to be cancelled on Aug 31st.  We were given no warning and found out a week after it had been cancelled when I went to get a prescription filled.   We have been told that they (BCN) will not reinstate it.  An appeal has been filed by my husband's employers insurance agent to have it reinstated but they do not seem hopeful that it will be.   We only have 30 days from the time of cancellation to get into another policy or with my son's pre-existing condition we would have trouble getting coverage for him for 6 months.  They are trying to push us into getting insurance through my employer. Problem is the coverage is considerably less than what we had and my son would not be able to see any of his existing doctors here locally and in CIncinnati.   They are telling us that in 3 months, if the appeal does not work,  they can re-write another contract or policy and get us the same insurance again (Is this true?).   Meanwhile they want us to take the insurance through my employer.  I don't know if I can believe this and am afraid we will get stuck with my employer's insurance.  Who can I call to get some answers?  Please, can anyone give me some advice?   I have called lawyers but they say that is not their specialty and that medical insurance issues are a very specialized area of law.  Can someone give me a name or direct me to someone that can advise?  Thanks for any help.

 

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Can't blame your suspicions for this one...sure doesn't sound right. I wonder if the Ins Co recently increased the employer portion of the policy. A one man "group policy" is very expensive for employers, there is no financial incentive for the employer to be candid with you. Follow the money.

Cheri Gunvalson said:
I'd contact the Insurance commissioners office for your state and ask them how to proceed, if you can settle this without a lawyer it will be better for all.
I still think that before they can cancel your policy you legally have to be informed in writing of the COBRA option.

Karen Barnett said:
You hit on every reason that I am so suspicious about what I was told happened (a survey & waiver getting turned in 5 days late).
This had me wondering, so I looked it up. I don't think you're entitled to COBRA for a circumstance like this. Even if you were, you'd be paying the full cost (what you were paying, plus what the employer was paying). For a family with a pre-existing condition like this, I'm guessing it would be crazy expensive. Probably more than you'll pay in additional copays and deductibles on the plan through your (Karen's) employer.


Qualifying Events - Qualifying events are certain events that would cause an individual to lose health coverage. The type of qualifying event will determine who the qualified beneficiaries are and the amount of time that a plan must offer the health coverage to them under COBRA. A plan, at its discretion, may provide longer periods of continuation coverage.

Qualifying Events for Employees:
Voluntary or involuntary termination of employment for reasons other than gross misconduct
Reduction in the number of hours of employment

Qualifying Events for Spouses:
Voluntary or involuntary termination of the covered employee's employment for any reason other than gross misconduct
Reduction in the hours worked by the covered employee
Covered employee's becoming entitled to Medicare
Divorce or legal separation of the covered employee
Death of the covered employee

Qualifying Events for Dependent Children:
Loss of dependent child status under the plan rules
Voluntary or involuntary termination of the covered employee's employment for any reason other than gross misconduct
Reduction in the hours worked by the covered employee
Covered employee's becoming entitled to Medicare
Divorce or legal separation of the covered employee
Death of the covered employee


link to more information on COBRA
I still think she will qualify as I am dropping below 50% faculaty status per my choice next semester and so since the College won't cover our health insurance I can go on COBRA for the family, it is $800/month for our family of 5.and then get back on in Sept when I will be at the proper %. They can only raise the rates once a year. It is worth a try. Cheri

Keith Van Houten said:
This had me wondering, so I looked it up. I don't think you're entitled to COBRA for a circumstance like this. Even if you were, you'd be paying the full cost (what you were paying, plus what the employer was paying). For a family with a pre-existing condition like this, I'm guessing it would be crazy expensive. Probably more than you'll pay in additional copays and deductibles on the plan through your (Karen's) employer.


Qualifying Events - Qualifying events are certain events that would cause an individual to lose health coverage. The type of qualifying event will determine who the qualified beneficiaries are and the amount of time that a plan must offer the health coverage to them under COBRA. A plan, at its discretion, may provide longer periods of continuation coverage.

Qualifying Events for Employees:
Voluntary or involuntary termination of employment for reasons other than gross misconduct
Reduction in the number of hours of employment

Qualifying Events for Spouses:
Voluntary or involuntary termination of the covered employee's employment for any reason other than gross misconduct
Reduction in the hours worked by the covered employee
Covered employee's becoming entitled to Medicare
Divorce or legal separation of the covered employee
Death of the covered employee

Qualifying Events for Dependent Children:
Loss of dependent child status under the plan rules
Voluntary or involuntary termination of the covered employee's employment for any reason other than gross misconduct
Reduction in the hours worked by the covered employee
Covered employee's becoming entitled to Medicare
Divorce or legal separation of the covered employee
Death of the covered employee


link to more information on COBRA
Cheri - yours is a qualifying event. "Reduction in number of hours worked" from the list above.

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