Topic: I just can't wrap my head around this one...
Melanie Reber
Frequent Contributor (5K+ posts)
Member # 3707
posted
Tonight I opened yet another letter from the newest health insurance company. It explained that my recent testing was not covered because I was not an eligible member at the time of services.
So, I called the insurance company to find out why I was not eligible. I pay my COBRA premiums now directly to my former employer, and I have paid every month, on time.
I was told, that I was not eligible, because my former employer cancelled their group policy.
I asked when this occured, and was told it became efective March 1st. I asked why I had not received any notice in the mail that I was no longer covered by this insurance company, and was told that "a letter was probably sent out".
The woman who was helping me, looked in her computer for a copy of "the letter", and could find no evidence of any such letter being sent.
I then asked just to clarify, if the employer had cancelled the policy OR if the policy was terminated due to non-payment. I was told that this information was confidential, and could not be relayed to me.
Sooo, for the 4th time in less then 8 months, this former employer has cancelled my health insurance with no forwarning.
Now, my recent doc visits, blood work, meds, stool testing...everything I have been putting off doing till I was certain that I could afford it under insurance coverage, will be out of pocket AGAIN.
HOW is this possible? How is this legal?
I simply cannot wrap my head around it tonight... but tomorrow, I will attempt to contact the CA Insurance Commissioner.
Have any of you been through this sort of insurance nightmare with an employer? I just can't fathom this as being a common practice.
Sorry for venting, it just has been an incredibly long journey and I feel so tired of fighting my way through this mess.
Melanie
Posts: 7052 | From Colorado | Registered: Mar 2003
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bettyg
Unregistered
posted
melanie, sorry to read about your latest fiasco; 4th time in 8 months they've done this to you!
it's a fulltime job for us just keeping track of insurance bills, payments, APPEALING, making copies of everything each time, phone calls galore and documenting each one, and on-line emails! STINKS TO HIGH HEAVEN!
that's what i was going to suggest contacting your state's insurance commissioner! reminds me i need to write their attorney again!
did i tell you folks i talked to this lawyer who couldn't answer my questions and said for me to call bcbs/wellmark ... the person/investigator who wrote the 2 letters to his office.
SHE REFUSED TO TALK TO ME NOR RETURN MY PHONE CALLS! she had a subordinate talk to me, and gave her copies of what she'd sent to the lawyer and my emails to his office!
good luck melanie! nail them!
have you contacted your federal senators/house reps as well as your state senator/house reps and involved them too? i hope so.
QUESTION: have you gotten an email from amkdiaries? she's trying for PA MD info.
she said she sent you an email but hasn't heard back from you.
if you go to DIRECTORY above under new post, type her name in 1st line on left side, and it will bring up her profile so you can send her a PM from there......thanks melanie!
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Jill E.
Frequent Contributor (1K+ posts)
Member # 9121
posted
Definitely call the state insurance commissioner.
However, they are not always right either. When a group plan I belonged to got dropped as a group, the CA state insurance commission said I had no options - just apply as an individual (which I got denied as) or apply to the state high-risk plan which has a waiting list.
It was the agent who handles my home insurance who told me that because I was dropped through no fault of my own, I was eligible for any individual insurance plan through HIPAA - they would have to take me, although they are allowed to charge a higher premium.
Hopefully you won't have to go that step - it sounds like you are on strong legal ground because you were never informed.
But do you have someone you trust who handles any kind of insurance that could do a little homework for you?
Take care, Jill
-------------------- If laughter is the best medicine, why hasn't stand-up comedy cured me? Posts: 1773 | From San Diego | Registered: Apr 2006
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Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
Keeping in mind it is after 4 AM and I haven't slept...
You said.. "Now, my recent doc visits, blood work, meds, stool testing...everything I have been putting off doing till I was certain that I could afford it under insurance coverage, will be out of pocket AGAIN."
May I suggest?
Tell the folks who don't want to pay these doctors and labs to take care of you...
That until they decide to pay the bills for your health care...
You will be sending THEM your stool samples each week.
Ok.. obviously NOT the best plan... but I will think on it and try to come up with a better idea.
By the way..
What about a lawyer at this point.. on contingiency? Can you sue the employer and/or all the insurance companies (or some of them) for aggravation, stress, jeapordizing your health, non-payment of medical bills, etc?
Can you figure out who your state and federal legislators are for me? Perhaps some calls from a patient advocate might help put pressure on them to get this straightened out?
They won't touch it IF you have a legal case pending.. so that would be a first step to see if they would.
Sorry I can't be of more help right now.
But ya gotta admit the stool sample idea couldn't hurt!
Geneal
Frequent Contributor (5K+ posts)
Member # 10375
posted
Dear Tincup,
You are so funny at 4:00 am!!!!!!!What a pile of cr@p anyway.
Melanie, please hang in there. I am sure that it is not legal, however you know
companies are notorious for "finding" memos sent when they really didn't.
I am praying for you and hope you can get the ball rolling with the State commissioner of Insurance.
Darn! Double Darn!!!!!
Everytime you over come an obstacle, another one is presented to you.
I know that you will over come this one too!!!
Sending prayers your way.
Hugs,
Geneal
Posts: 6250 | From Louisiana | Registered: Oct 2006
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Melanie Reber
Frequent Contributor (5K+ posts)
Member # 3707
posted
Thanks to each of you.
Fortunately, I have saved all letters and notes re: all my health insurance problems from day one with this former employer. I actually have most already copied and the whole story written out due to my recent Unemployment Insurance Denial hearing.
The judge at that hearing was amazed over what I had been through with all of this, and I think this was a large player in why I was awarded Unemployment Insurance. It was obvious to her that the evidence of my voluntary resignation was convincing and overwhelming.
I guess this weekend will be spent finding all my medical records and expenditures too and trying to figure those out as well.
I heard through my pharmacist that there is a free legal aid available through the county in which I reside, so that is an option for me to try and get this all ``in the system''. But, as you say, TC, I don't want to begin any legal proceeding without first going through the proper channels. I think my first move is to contact the Insurance commissioner and see what he says about it all...so I will know exactly what my rights are here.
Then, I will get any one else involved as needed, because I am just tired of playing around with these people. And, I do feel as if this has been a game with them...as in lets see how far we can continue to push the envelope without actually getting nailed on it.
The one and only thing that has kept me from this ultimate decision, is that IF my former employer is denied insurance coverage for playing these games, I will be as well, as I am COBRA'ed and basically have to go with whatever they do at this time. I simply can not afford to pay more for an independent policy. I am already paying as much as I can with the full premiums and with med bills that are not covered under any insurance.
Miss Betty, Yes, this has all been a full time job for me just trying to keep my head above water. That hasn't left me with much time to actually find a full time job to get out from underneath all of this! It has been a vicious cycle for certain.
I am so sorry you are having issues as well, seems like most of us do, and it just feels so wrong. As I said above, I will get whoever necessary involved at this point, thanks for your ideas. And no, I have not had the time yet to respond to the person you sent my way. I have only actually been home about 3 days in the last 2 weeks, and am very behind on all emails. But, I will try to get to her soon.
Hello Jill, Thank you for your insight, and I am sorry that you too have had to deal with this. Yes, I know that one can get different answers from the same organizations on any given day- very frustrating indeed. I honestly can't afford to pay a higher insurance premium right now, I am barely making my monthly expenditures as it is...but we shall see.
I wish I did have someone close by that knew the inner workings of health insurance issues, but I do not.
What I failed to mention as well, is that a few days ago, I received another letter from my last insurance carrier, the one that was supposed to carry us through December but didn't because the company did not have ANYONE insured for that month. Anyway, my premium for that month was returned in January, and the firm said that any costs above my premium would be paid for by them.
The letter was asking that I repay them for about $350 of medication I purchased that month. This is less then what my December premium was, so I will have to repay them.
The point being, I was not insured for December at all, therefore, none of this will count toward a deductible. This just seems so wrong.
Hey TC, I have found that I can not trust my former employers as far as I can throw them...so going to them with any sort of bill is just a waste of time. Part of why I resigned was BECAUSE they were not paying their bills, including paying us!
They are well aware of my medical conditions, and still do this to me, and every other employee in the firm. That should tell you something about their ethics. (Which is another reason why I resigned)
I have tried so hard to keep up with all my current medical bills since I moved to CA...lets not forget my three years of unpaid med bills while I was sick in Colorado that still sit in a box under my table.
I really am not trying to complain here, I am so very well aware that I have it better than most, and we all have these issues to overcome. I suppose I am a bit more affected by this presently because I just passed the 4 year mark of dealing with this, and another 20+ years before that with no diagnosis. One tends to take stock of their situation on these anniversaries...and I just find it hard to accept that THIS is my life now.
I try so hard to continue to find meaning through all of this- I just have to, to keep sane and keep plugging away. But even that is becoming more difficult, ya know? Yes, I KNOW you do. Thank you for all that you do.
Miss Geneal, As usual, you are so supportive and a blessing with your steadfast faith. I really do thank you for that gift. I am usually a woman of unwavering faith as well, so thank you for reminding me that eventually all will be well.
Much love to you all, M
Posts: 7052 | From Colorado | Registered: Mar 2003
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just don
Frequent Contributor (1K+ posts)
Member # 1129
posted
Melanie, Just know there is a silent "CROWD" of fellow lymies out here rooting for you,,,supporting your every move,and cheering every little victory and crying with every little 'setback'. YOU will pervail,thats who YOU are!!!
I thnk every effort you can muster should be thrown into the 'get a new job' effort. It would solve so much, from every angle,,,think "GROUP" insurance again. Your next employer will NOT be such a knothead as the last,,,just cant be, no way!!!!
In the 'meantime',,,is their any old co-workers you can rub shoulders with and stay in the loop as to whats going on there these days?? Even if you visit about the weather for 3/4 the talking time, and insurance 1/4 time. Somebody you can call on the phone,talk a couple minutes,find out what you want to know and get outta there??Another lady who you can talk ,"GIRL talk" with???
Resign the fact that this former company is playing games,they are going to continue to play games,they will ALWAYS play games. The OTHER employees still there have to be also so fed up,,,is there any other employee who is medically challenged like you are,,,and this is biting them,just like YOU???Thats who you want an alliance with!!! But ONLY when you have other employment(read other group insurance)can you really play "HARD BALL" with them.
It is NOT "NICE" what they are doing to you, but I seriously doubt they are doing what they are doing,,just for your pain!! They just arent aware or dont care what is going on, they are on a bannanna peel and grasping at financial floating debris,to keep from drowning in a ocean of debt!! Their financial ducks are about to crumble and they are delaying the 'pain'(there's) as long as possible
Is this a pubicly traded company,,,or a privately owned firm?? Do you know who actually owns them, and who their investors are,if any???Good info to KNOW for later.
Believe me,,,we ALL feel your pain,,,we really do!!!specially since being--just don--
-------------------- just don Posts: 4548 | From Middle of midwest | Registered: May 2001
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trueblue
Frequent Contributor (1K+ posts)
Member # 7348
posted
I can't offer any better than what has been said so far.
I also think insurance commission, legal aid, stool sample to ex-employers.
I know what they have been doing is completely illegal. If they were punished by not having available insurance to them, they would still be responsible for yours, that's the deal you had with them as employers and they have broken that contract repeatedly. They deserve big time punishing.
If you want to vent/talk/babble... let me know I may not have the best answers but can listen pretty good. I'm sorry this has happened again, Melanie.
-------------------- more light, more love more truth and more innovation Posts: 3783 | From somewhere other than here | Registered: May 2005
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Melanie Reber
Frequent Contributor (5K+ posts)
Member # 3707
posted
Well, I have spent all moring trying to track down someone who could help me.
This particular insurance company, BC of CA (PPO), is not regualted by the CA Dept. of Insurance, but by the Dept. of Managed Healthcare.
A quick call to the consumer information hotline told me that because this was not an issue entirely with that insurance company, but an ongoing issue with my former employer, that I needed to contact the State Labor Commissioner.
The State Labor Commissioner told me that because I was under COBRA, I needed to speak with the US Dept. of Labor.
The US Dept. of Labor does not answer the phone apparently between the hours of 11-1:30, when I gave up trying.
So, I went to their website and found my local State Labor Office. YES! A real person, who was willing to help!
Mr. Conner told me that this was indeed a US issue and not a State issue, so I needed to keep trying the US number. BUT, he also gave me two other numbers to try, and if I did not get anywhere after that, to call him back, and he would assist me further.
I am spent for the day now, and really need a nap, but also have errands to run.
So, this will now have to wait till Monday...and hopefully by then, the COO of the former firm involved will have answered my email sent to him at 7:30am, requesting a written reply today, as well.
Hey Don, I really AM doing my best to find employment. I have had 2 interviews recently, so hopefully something will come along soon.
I also know that I am not at my best, and beginning a new job in this shape will be very difficult, but I really have no choice.
Yes, I am in contact with past and present employees of this firm. The games never cease. They are still not paying on time, and are still giving everyone the same old "the check is in the mail" run-around.
Those who are still employed do not want to risk jepordizing their positions, and those who have left, are not under the same COBRA PPO that I am under, so I do not have anyone who I can team up with on this.
And yes, this is a privately owned firm. Thanks so much for your support!
Miss Cavers, What can I say?
Bluebird, I do appreciate your offer to vent or whatever, really. I too am sorry this is happening again, but feel like I am making some progress at least in weeding out who NOT to talk too, right?
Much love, M
Posts: 7052 | From Colorado | Registered: Mar 2003
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I just want to fly to CA and kidnap you and bring you to TN where most "public officials" are too dumb to be dishonest and pretty much still care about people.
My CA daughter calls me and leaves me these messages on my answering machine that are COMPLETELY inaudible, they are so fast. And she tells me she has to call me only when in her car because she is just too busy otherwise.
I once wrote a poem called "When California Slipped Into the Sea at 3:00 AM".....HONEST! Now I shouldn't besmirk CA as a whole. (Some of my best friends live there or have lived there or know someone who lives there or have visited there.)
It's just I HATE how you've been treated! You are just too good and gentle a person to be hammered this way. I guess my anger isn't going to help you any but I am riled up.
So, OK, I WILL pray for you and I know that prayer DOES work, maybe not in our time, but our dear Savior has a perfect plan for us all....and yours should be miraculous when you learn what it is!
You are in my heart where I keep the best people I know and love, Janet
-------------------- DISCLAIMER: No information presented above should be considered medical advice or take the place of advice given by a medical professional. Links to other sites are provided merely for ease of research. Posts: 287 | From Tennessee | Registered: Sep 2006
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lymewreck36
Frequent Contributor (1K+ posts)
Member # 4395
posted
Well folks, I can tell you that when I lived in Connecticut, our insurance carrier kept refusing to cover a 3 week IV rocephin. They sent me appeal dates, we did the paper work within the dates, and then they pointed out I missed the target dates. I studied the appeal instructions and highlighted the many mentions of time frames, and discovered that the papers contradicted themselves all over the place.
Then I tried to expose the confusion the insurance company appeal instructions created as a reason for accepting my appeal, but I was told I did not do that in the correct time frame either.
And let me tell you, I was working feverishly to put pressure on the insurance carrier. I wrote to Oprah about insurance practices and asked that she do a show on it. I wrote to the Attorney Generals of two states. I wrote to DAteline. I wrote to the local news station. All of this letter writing copied to the insurance carrier.
Everytime we would talk to someone in the insurance carrier's office over the phone, we would be told something that the next person we talked to over the phone would say was not accurate, or was never said.
So my husband got wise and stated keeping a log by the phone of every phone call, the time the call was made and how long it was, whom we spoke with and their supervisor....etc.
Finally, we caught the insurance people in their own trap. We appealed to the Attorney Generals of New York and Conneticut again, this time with all the references and detailed information of phone converstations. That is what got them.
In the end, they could not deny the information they were giving us because we kept such good records, and they were pressured to allow my appeal. Then my IV was covered, but they made sure to tell me it wasn't because I was sick with lyme, but because of their own errors in instruction.
Who cares! I got'em. They hated me and even referenced that I reported them to the state when we called for future questions.
They never fought me again after that. They were quiet.
It took 12 months, and at times I would cry over the injustice. My husband would tell me to drop it because it was affecting my health, but I wouldn't.
Don't give up. You are in the right.
BEst of luck with it and my deepest sympathy that you have to go through this.
Mary
Posts: 1034 | From North Carolina | Registered: Aug 2003
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trueblue
Frequent Contributor (1K+ posts)
Member # 7348
posted
True Melanie... but you did find Mr Conner! Good weeding!
-------------------- more light, more love more truth and more innovation Posts: 3783 | From somewhere other than here | Registered: May 2005
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trails
Frequent Contributor (1K+ posts)
Member # 1620
posted
Posts: 1950 | From New Mexico | Registered: Sep 2001
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kam
Honored Contributor (10K+ posts)
Member # 3410
posted
Sheesh. I sure hope this works out for you Melanie and soon.
Posts: 15927 | From Became too sick to work or do household chores in 2001. | Registered: Dec 2002
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posted
Melanie, This is too much to deal with in addition to coping with Lyme itself.
Prayers that you will find peace and calm in the midst of this and the insurance issues will resolve quickly so you can focus on healing.
Posts: 628 | From the south | Registered: Dec 2005
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hopeful123
Frequent Contributor (1K+ posts)
Member # 3244
posted
hey melanie,
i am SO sorry that you are experiencing this, again! this is my thought. i remember seeing a news show on hospital medical bills for uninsured people who had had surgery. all i can remember is that the hospitals involved were billing these uninsured patients at an INSURATE RATE and that it was the state regulating insurance agency who helped these folks get the price down to where it should have been in the first place.
i know that this is going at the problem in a different way and that you want the insurance company and your former employer to be held accountable, but maybe this might be useful in the future.
anyway, i hear your frustration. i am sorry these guys are such idiots!
-------------------- some days you're the bug, some days you're the windshield Posts: 1160 | From NY | Registered: Oct 2002
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hopeful123
Frequent Contributor (1K+ posts)
Member # 3244
posted
thant's Insured rate!
-------------------- some days you're the bug, some days you're the windshield Posts: 1160 | From NY | Registered: Oct 2002
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Melanie Reber
Frequent Contributor (5K+ posts)
Member # 3707
posted
Good morning my friends,
Thanks so very much for your support and feedback. I'm sorry I haven't replied until now...I had to leave home unexpectedly Saturday and am still away.
I hope to make a few calls this morning from here to see if I can make any progress with this today. I am again out of 2 of the 12 Rx meds needed, and these alone are over $350 out of pocket.
The Firm has not replied to my email, so I will also try to make calls there to at least give them an opportunity to explain things...we shall see.
Miss Janet, You really are a love...thank you for all of the support and kindness you show to me and to so many others. I also believe in the power of prayer, so I will take that...and bless you for thinking of me.
Hello Mary, Wow, I am so very sorry that you have been through your own personal nightmare with insurance. It looks like your perseverance paid off, although I am certain at the time, it seemed hopeless. Good for you and for Hubby for sticking it out and finding a way to get things settled! Thanks for the encouragement!
Blue, Trails and Miss K, Thank you for your support, I know you each are well aware of what is happening here, and I so appreciate all of your help.
Serendipity, You too are so appreciated for all that you do and for all that you are.
Hopeful, Thinking out of the box may be required here for a resolution, so thank you for the suggestion of a backdoor approach. It never hurts to brainstorm all possible options.
Love and many thanks to you all, M
Posts: 7052 | From Colorado | Registered: Mar 2003
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Sheesh. I sure hope this works out for you Melanie and soon.
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