they cancelled my health insurance (I just had surgery) - page 2
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... Read More
Nov 20, '07Occupation: R.N. Joined: May '07; Posts: 3,228; Likes: 3,680When must group health plans and issuers provide the
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
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.
Looks like your employer and insurance carrier have some 'splainin' to do.
Nov 20, '07Occupation: 20+ yr RN Specialty: 15 year(s) of experience in Critical Care ; From: US ; Joined: May '05; Posts: 7,520; Likes: 4,030Either 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.
"Protecting Your Health Insurance Coverage" - this is a .pdf from the gov't.
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.
Timothy.Last edit by ZASHAGALKA on Nov 20, '07
Nov 20, '07Occupation: Hospice nurse Specialty: 18 year(s) of experience in Corrections, Cardiac, Hospice ; From: US ; Joined: Mar '04; Posts: 1,082; Likes: 2,527Oh, 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.
Nov 20, '07From: US ; Joined: Jan '06; Posts: 13,193; Likes: 17,911Hey, 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.
Nov 20, '07Occupation: 20+ yr RN Specialty: 15 year(s) of experience in Critical Care ; From: US ; Joined: May '05; Posts: 7,520; Likes: 4,030Quote from ShayRNThat'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.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.
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.
Timothy.Last edit by ZASHAGALKA on Nov 20, '07
Nov 20, '07Occupation: Paramedic Specialty: 23 year(s) of experience in Peds Cardiology, Peds Neuro, PICU, IV Jedi ; From: US ; Joined: Jul '05; Posts: 1,084; Likes: 466I 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.
Nov 20, '07Joined: Jun '06; Posts: 7,199; Likes: 7,934you dont happen to have a very common name? perhaps they cancelled the wrong "jane smith" sort of thing?
Nov 20, '07Joined: Apr '06; Posts: 11,159; Likes: 11,316I 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!Last edit by HM2VikingRN on Nov 20, '07
Nov 20, '07Joined: Apr '06; Posts: 11,159; Likes: 11,316Frankly, it is cases just like this that are the single strongest argument for a single payer system.
Nov 20, '07From: US ; Joined: Jan '04; Posts: 3,163; Likes: 1,158OMG. This is just awful. I think they cancelled your health insurance on purpose because they knew you were going to have surgery.:trout: This is absolutely shocking!!!!! I wish you the best of luck. Hugs to you.
Nov 20, '07Occupation: SAHM, for now. From: WI, US ; Joined: Feb '04; Posts: 2,574; Likes: 322This whole thing smells to high heaven.
I'd like to know how this turns out, keep us posted, OK?