they cancelled my health insurance (I just had surgery) - page 3

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

  1. by   purple1953reading
    I WOULD NOT GET THE LAWYER FIRST. I would FIRST find out if I really have health insurance or IF I have what is now called a third party payor. Unfortunately for us, almost all big companies have now gone with the third party payor route. THIS Means that they LEASE a list of providers, and that is the part of the plan that decides if it is covered, and how much they will pay. The other part of the plan is the payor. IN the state where I live, and I imagine this is all over, third party payors are NOT responsbile to follow the guidelines of the insurance comission of the state. BECAUSE THEY ARE ESSENTIALLY NOT health insurance. I found this out a long time ago because I was in a car wreck, and in our state, as long as you don't have MEdicare or Medicaid then you can collect from the drivers at fault's insurance on the car, AND your health insurance. I had ins. and my husbands ins. They paid all the claims, but then turned around and filed against the money I had coming from the other drivers car ins. IT took over 2 years to get that money back. The state insurance comission told me that I did NOT have health insurance as the company called it, but a third party payor, and the only thing they are governed by is the federal court system. THey do NOT have to comply with any type of insurance regulations of your state. Up to that point, I never heard of a third party payor. I urge all of you to call the insurance commission of your state and CHECK OUT your own "health insurance".Many of you will find,like I did,that I do not have health insurance. I fought the employers to no longer advetise that our"health insurance" was such a great benefit of our employment. I was told by several attorneys that had gone against third party payors, because they did not pay in accordance with the insurance commission, that USUSALLY judges will hold them to the standard of what health insurance is required to do,but they do NOT HAVE TO DO SO>

    As for "registered letters",believe me they do not send anything registered, in fact many disguise the way they send it out, so if you are not careful,you may not even open it, when you get the Cobra letter. I believe that you have 60-90 days to decide to go with Cobra IF you are offered it. BUT the cost is prohibitive. For example, you pay around $150 for family benefits monthly at work,but you pay $1400 monthly on Cobra.SO even though it is offered, without a good job, many cannot afford it. In addition, if you apply for health ins, through another provider during the time limit, because you were insured longer than a continuous year, they have to pick up WITHOUT a pre existing clause. IF you don t do it within this time, they can add any clauses, and you may have to work months to get health insurance. I wish you the best, but it is not as easy as get a lawyer and sue. I would think that a hospital would not enter into something like this, without having done their homework. IT makes no sense. They no somebody would turn around and try to sue. IS your job secure to come back, you have had accumulated vacation, etc, or are using FMLA? IF you have not taken the proper steps. this will prove much more difficult. What did you find out today?
  2. by   crissrn27
    Hopefully, it is just an oops. Who exactly told them to stop taking your payments out of your check? I don't get it. HR should have received a form from YOU requesting payment be stopped, and if it wasn't open enrollment, and it wasn't a change in your employment status, it just doesn't make since.

    I'm sorry you are having to deal with this, especial right now, when you should be focused on recovery. Let us know how it works out. And feel better soon!
  3. by   leslymill
    Quote from Blackcat99
    OMG. 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.

    It is so shocking I was thinking about it at work today. Keep us posted. It is just too wrong to describe. If they canceled your insurance because they knew you would need it, they should simple GO TO JAIL....GO DIRECTLY TO JAIL......

    Keep us posted. If it happened to you, a health care worker, it could happen to anyone.
  4. by   CseMgr1
    Quote from HM2Viking
    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.
    I agree. Whether your employer's health insurance plan is self-funded or their insurer assumes the risk, something is definitely "rotten in Denmark" here...and I would enlist the services of a competent attorney and file a complaint with your State's Insurance Commissioner's office ASAP.
    Last edit by CseMgr1 on Dec 1, '07
  5. by   Tweety
    What they did was illegal plain and simple. I hope you can get it resolved. As someone stated above, now is not the time to play nice. Bring out the big guns.
  6. by   banditrn
    I seriously think I'd be getting a lawyer to straighten it out!
  7. by   purple1953reading
    What did you find out, is this straightened out now?