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    Need some advice (if possible?)

    OK not sure this is the correct “room” so please re-categorize as necessary.

    In short I am having a massive insurance issue due to my employer mistake. I have MS like all of us, and like everyone painfully knows it comes with a commitment to high insurance bills on a regular basis.

    I took a role at company (beginning this year) who was not based in my state. We quickly found out their insurance plan would not cover services in my state. So we never joined that, and instead used Cobra as primary plan until I could get one from the marketplace.

    After speaking with the Cobra administrators, and explain situations, they said that it was perfectly OK to do above, and so we proceeded.

    Unfortunately, the employer never canceled the other plan, despite me sending e-mails reminding them. Fast forward to now:

    The employer’s plan, that has no to little coverage, was never supposed to exist, is now being deemed my primary. My last year of claims (80k) is now all getting rebilled, and good chance it will now jeopardize Cobra and potential will cancel.

    I am terrified, as that is a lot of claims, that I have already paid, meet deductibles, and good chance a lot might simply not be covered and now I will be responsible for the claim on them.

    I can’t get confirmation from my employer that they will help cover my finical set back due to their mistake.

    Will I need to get attorney’s involved or does anyone have resources I can discuss with some on this front?

    Thanks,
    -Dave

    #2
    Emails are legally binding. Please do what you can to preserve them- print them out AND if on your employer´s server/system, go back and FORWARD them to yourself at a non-employer email address to be sure that even if "lost", aka- erased, you still have copies.

    I would think that you could save on legal bills by showing HR your copy of the emails- after having preserved them.

    Comment


      #3
      Hi Daveo:

      You might need an attorney to straighten out all the pieces. For starters:

      If you never signed up for your employer's plan, how can there be a plan to cancel? And if there was no plan to cancel, why did you need to send them emails? And if you were mistakenly enrolled in your employer's plan, why wasn't your policy canceled after the first month when you didn't pay the premium?

      Who decided that your employer's plan is your primary carrier? How did the COBRA administrator first determine that you didn't have other coverage and then determine that you do? Did you get anything from your COBRA administrator's first determination in writing? It might be that the COBRA carrier has some responsibility in this as well.

      How the situation turns out might depend on a legal determination about fault, so having an attorney might be necessary to determine if your employer has proof that you were actually enrolled in their health plan. Good luck with this. I hope it turns out OK for you..

      Comment


        #4
        Ugh ... why does MS complicate life so much

        @all thanks for the replies .. I think there is a good chance I need to get a attorney involved since the company I worked for hasn't fully confirmed that they will cover the costs, due to their mistake.

        @jreagan70

        In short, I signed up for all the benefits, which part of that is insurance. Via discovery we found that the insurance plan would not really cover services for me in Washington (they are located in CA I am their first WA employee). I talked with Cobra administrators, who confirmed I could stay on the cobra plan if it's my primary, as my offered plan was a less, and well flat out not cover necessary services. (their official answer was we don't know if they are covered, run a claim through and we'll see ... which is NOT ok, I am not going to run 4k dollar claim and hope it's "covered")

        So we (HR/Managers, etc..) all agreed for me to stay on Cobra, and they were going to pitch into that cost. (I have this agreement in e-mail, and they were paying 100% of cobra for me, so also clear intent) Unfortunately HR never canceled the plan.

        I found out 4 months latter when I had a 3day run of IV steroids, and somehow (I guess hospitals etc.. can see all plans a given social security number has, they billed the wrong plan .. and all this started to unravel. I didn't even know the plan existed, it was shocking for me to call them give them my name, soc., b-date, and they said oh yes you do have a plan 8-(.

        @Temagami - yes I have absolutely "saved" the e-mails and sent them to 3 personal accounts .. lol..lol..

        I am hoping the employer makes right on this, as it's their mistake, but I haven't gotten written confirmation that they would, which makes me concerned, going to lawyers sounds like a utter nightmare, and a hoop that seems verry possible they will make me jump through.

        Still baffled how a mistake by others, can directly impact me financially, as these bills are tied to me not the company. 8-(

        Comment


          #5
          Sorry, Daveo. The whole situation sounds horrid. I guess it's too simple for your HR manager to just get on the phone with the COBRA folks and say, "Oops. Our bad. There is no other policy. In fact, we're the ones who have been paying you. So false alarm. Just go back to what you were doing." Well, one can hope.

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