they cancelled my health insurance (I just had surgery)

Nurses General Nursing

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I had been planning on having surgery for about 4 months and had discussed it with my manager so she was aware. I waited 4 months because we were short-staffed and it would make it hard on everyone with my being off work. When I finally decided I needed to do it, my manager asked me to wait another month, so I did. Well, Oct 15 I had my surgery, Ive now been off work for 5 weeks and got a notification in the mail 3 days ago that my insurance had been cancelled 2 months ago! I was never notified. I called the insurance company, they said that my workplace sent them a letter on Nov 6 to cancel it effective September. Now I have this huge surgery bill, I cant afford my meds, etc. We just had our open enrollment 2 weeks ago, I did my paperwork with no problems, nothing said or mentioned about any cancellation. So to my knowledge, I still had insurance. I pulled out my old paystubs, they had stopped taking out my premiums a couple months ago! What can I do? I mean, its their fault, not mine. At the time the premiums stopped coming out of my check was the same time I got a raise, so I didnt notice any change in pay, no need to investigate every paystub. Our paystubs are so confusing, no one looks at them because they make no sense. I trusted them, took for granted everything was ok, Ive had insurance for 2.5 years with them with no problems. Anything I can do about this? Its almost like they are wanting to get rid of me.

I agree with Imustbecrazy. Great advice.

You need an attorney now.

When must group health plans and issuers provide the

certificates?

Plans and issuers must furnish the certificate automatically to:

an individual who is entitled to elect COBRA continuation coverage, at a

time no later than when a notice is required to be provided for a qualifying

event under COBRA;

an individual who loses coverage under a group health plan and who is not

entitled to elect COBRA continuation coverage, within a reasonable time

after coverage ceases;

Can I lose, or be charged more for, coverage if my health status

changes?

Group health plans and issuers may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan based on “health status related factors.” These factors are your health status, medical condition (physical or mental), claims experience, receipt of health care, medical history, genetic information, evidence of insurability or disability. For example, you cannot be excluded or dropped from coverage under your health plan just because you have a particular illness.

http://doi.ppr.ky.gov/kentucky/Documents/pubs/HIPAA.pdf

Looks like your employer and insurance carrier have some 'splainin' to do.

Specializes in Critical Care.

Either it's a simple mistake, or, it's not.

IF it's a simple mistake, once pointed out, it should be easily fixed.

If it's NOT a simple mistake, then, most likely, they will tell you that YOU cancelled your own policy. (They can't cancel it for you).

If you hear anything other than 'we'll fix this, right away', this is what you should do: you should point out that dropping your coverage is a HIPAA violation and that you intend to file a Civil Rights complaint with the Federal dept of Health and Human Services. (Print the booklet 'Protect Your Health Insurance' linked below and give a copy to your HR director)

HIPAA doesn't just cover privacy. That's a small part of that law. It also covers how employers must be accountable for any insurance policy that qualifies for the gov't tax break they get to provide insurance to you. There are standards, and conspiring to deny you coverage is, duh! - a violation of those standards. Health Insurance Portability And ACCOUNTABILITY act of 1996: HIPAA.

Most healthcare related employers have been scared to death about the consequences of HIPAA and so, that should get a reaction.

If it doesn't get a reaction, get a lawyer. Make a Federal CASE out of it. That shouldn't be too hard, since Federal Cases are the ones that make lawyers salivate over federally directed legal payments as part of the settlement.

Either they step up to the plate, or, it's time to play hardball. Now, don't quit your job. No. If the game turns mean, let them FIRE you. Bingo. Then you're talking back pay in the whole deal. There are very few things that employers can't get away with. This is one of them.

These rules are FEDERAL rules. They aren't optional.

Give them one chance to be nice and make amends. Afterwards, make sure they know that not dealing with you is much more hazardous to their bottom line than putting you back on the insurance policy would be.

Middle managers move to the tune of not having to report bad stuff up the chain. An HHS HIPAA related Civil Rights complaint: that's one of them there bad things.

Good luck.

Start here:

"Protecting Your Health Insurance Coverage" - this is a .pdf from the gov't.

http://www.cms.hhs.gov/HealthInsReformforConsume/Downloads/protect.pdf

Where to file a complaint: (HHS Office of Civil Rights)

What information is needed to file a complaint the HHS Office for Civil Rights?

When the gov't grants a tax break so that you can get employer-provided insurance, for your employer to drop that coverage is tantamount to denying you a gov't provided promise of coverage. When such a drop comes in the face of you needing to use that insurance, that is a civil rights violation.

~faith,

Timothy.

Specializes in Corrections, Cardiac, Hospice.

Oh, I would also demand a copy of the letter that the insurance company claims my employer sent them. The one dated Nov. 6 stating my insurance was cancelled the month of Sept. I mean, that just sounds so odd to me.

Hey, that's illegal.

Get a lawyer. Now. NOW.

In case I wasn't clear, get a lawyer. This minute.

The word is lawyer. The time is as soon as you read this.

What they did is completely illegal and against federal law.

Specializes in Critical Care.
Oh, I would also demand a copy of the letter that the insurance company claims my employer sent them. The one dated Nov. 6 stating my insurance was cancelled the month of Sept. I mean, that just sounds so odd to me.

That's not as odd as it sounds. The employer will just say that is when premiums stopped being paid, and so, the date premiums ceased becomes the effective date of cancellation.

What you want them to show you is their proof that YOU authorized that your coverage be cancelled. There should be some written record of that in order to PROVE compliance with the law.

Since they don't have such a form, they will have no case to stand on.

This site does not offer legal advice, so we want to avoid that. However, I would at least give them a chance to settle it fairly before resulting to a lawyer. It's a fact that you want to maintain a good relationship with your employer if possible. So, give them a chance to fix it. If it's NOT fixed, pronto, THEN, get a lawyer. Pronto.

~faith,

Timothy.

Specializes in Peds Cardiology,Peds Neuro,Pedi ER,PICU, IV Jedi.

I must be crazy is EXACTLY right. Furthermore, WHY did your employer tell anyone to cancel your coverage? I'd be chewing someone's @ss for that one.

They can NOT, legally, cancel your insurance without notifying you - in writing. You didn't get that certified letter? I agree with others here, especially those who tell you to get an attorney. NOW.

I don't know about anyone else, but your employer's looking pretty shady. I'd consider other employment.

Good luck

vamedic4:angryfire

you dont happen to have a very common name? perhaps they cancelled the wrong "jane smith" sort of thing?

keep us posted

I am too cynical about this one. You tried to schedule surgery. You gave advance notice, delay it at your managers request, have the surgery and presto your insurance was cancelled. You were dropped (it appears) because the HR dept didn't want to pay a claim that would drive the rates up for your employer. I would create a chronological file with every date and email between you and your manager that documents your side of the story.

1. Get a lawyer.

2. Look for a new employer.

Best of luck!

Frankly, it is cases just like this that are the single strongest argument for a single payer system.

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