I am currently 19 weeks pregnant, and due to negligence of the husband's company's HR dept have no insurance. We married on Novemebr 27th of 2010, and had planned to drop my coverage (higher premiums and copays with similair coverage) and add myself and my oldest son from a previous marriage (16) to his insurance. I called my insurance provider approx one week after the marriage to report the qualifying life change, as did my husband. My company got the matter taken care of quickly, and my provoder sent me a HIPPA letter of coverage within two weeks.
We just discovered today, that my husband's HR rep did not send the necessary paper work to the insurance company until December 29th, therefore missing the 31 day deadline. We were informed that although the info is in the system, my son and I are not covered until March.
I am currently 19 weeks pregnant, and due to 2 prior c-sections and being 36 yrs old, I am under more than the average amount of monitoring. Two weeks ago I was told in my third ultrasound that I mave developed placenta increta, and though my blood tests and nuchal measurement look normal, the baby's brain development is somewhat consistant with a trisomy 18 chromosomal defect. My doctor and specialist would like to monitor both conditions, but unfortunately everything is at a screaming halt now due to the lack of insurance. My coverage ended on December 31.
I would love to hear anyone's ideas on what could be done.
Thanks
Thank you all for your encouragment. We were able to get my husband's HR dept to contact the insurance company and correct the situation. They agreed to make the eligibilty date retroactive to the date that my husband turned in the paper work to the HR rep. We had to make several calls to both HR as well as the insurance company to be sure that the issue was being handled, and was going to be resolved quickly.
It is such a relief !
Thanks again to everyone !
I worked in an HR department for 2 years. The fact is this situation could be fixed if they made the effort. Be polite and persistent. Take it up the management chain. The person you are dealing with now might not be the person who can help you.
If the company is at fault I would go to them and ask them to cover the bills until you are eligible for coverage. They dropped the ball...
Under amendments to ERISA by the Health Insurance Portability and Accountability Act (HIPAA), a group health plan is required to give you a "special enrollment period" if you have a triggering event (such as marriage). You are required to notify "the Plan" within 30 days of the event. "The Plan" would typically be your employer (under ERISA, the Plan Administrator is the employer sponsoring the Plan, not the insurer), so the fact that paperwork was not sent to the insurance carrier on a timely basis should not matter to the insurance carrier at all if your event was timely reported to the Plan via your husband's contact with his employer, the Plan Administrator. Call his HR dept and tell them they were notified in time and in accordance with the Special Enrollment rules established by HIPAA, your effective date of coverage should be the date of your marriage. Good luck!
Most states offer a version of "Pregnancy Medical" which covers pregnant women who are uninsured. You are under obligation to report change in that status (aka in march, you'll switch onto your husband's plan).
HOWEVER
I would raise hell with your husband's company. If you have all of the paperwork, dated, etc... they may very well be on the hook LEGALLY (in addition to morally) to cover all of your healthcare expenses until then. Their screwup, they should fix it. I'm quite certain the state would agree, and they could very well get into big trouble legally for this mess.
If you can prove that the paperwork was submitted to HR within the guidelines, I would have the HR department send a letter to the insurance indicting that it is their fault that the deadline was not met and that you and your son should be covered.
If HR refuses, I would tell them that I will be sending all the medical bills to them to pay. I know I would not let my company get away with this.
I agree with Lynn. I used to do benefits in HR.
1. Go directly to the VP of HR. Give him/her all pertinent information, If your husband filled out a form, tell the VP the date he completed the form and submitted it to HR. As long as he did that within the 30 days, they should be able to correct the clerical error.
2. Now, if he didn't complete it and is afraid to tell you, then you should still be able to pay for coverage with your employer at COBRA rates. Crazy expensive, but it should bridge the gap in your and your son's insurance coverage.
3. If for some reason, your husband's employer says they can't correct the problem they caused, push them to pay either for your COBRA with your employer or private insurance in the meantime. They can do this. They can "fix" the problem by unconventional means.
I would call or write to the HR department and demand that they make you whole, meaning, that you do not absorb the finacial responsiblity for thier error. Tell them you consider this thier error, and they have a responsiblity to fix it, or you will report them to the insurance commision and seek mediation, and if necessary, seek an court order to gain your benefits, and hold them responsible for your attornys fees.
Some thing like this happend to us when my husband went on deployment, and the company HR department suspended a payment while he was gone, and then faild to restart it once he came back, causing us a huge tax bill. At first, they would not deal with me, and said that there was nothing they could do, and then when I insisted, and wrote to them saying that this was thier mistake, and that the only solution I would accept was for them to put us back in the posisition that we would have been in had they not made the error, they relented, and took care of things, though it cost them some money. It is their mistake, go over thier heads.
M.
Wow, that is just awful. Bureaucracy at its finest.
If you have the money, I'd suggest talking to an employment attorney. I'd guess that your company has some sort of legal obligation to report your changes to the insurance company in a timely manner. I'm not sure how that would work exactly, though, because my company had us interact directly with the insurance company for those sorts of things. But if your company is insisting on being an intermediary, they'd have to have some sort of responsibility to that end.
Is there any way you can get back on your old insurance, at least temporarily until this is resolved? Even if it does mean higher premiums.
I am in HR. You and your husband should set up a meeting with the top dog in HR. Make sure that all the paperwork on your end was in order. If so, the company messed up and should be able to rectify this situation. Remember, you are not an employee of the company so therefore the company does not have the deal with you. This is a big mistake and the company should make every effort to make it right. Good luck! FYI - keep good records of all contact with the HR dept. including who you spoke with and their title.
I believe there are a few things your can do:
1. Assuming your husband's HR department had the necessary info from you on time, contact your husband's HR department. They are well aware of the timeline necessary to make these types of changes and should have taken the necessary steps to handle then change. Explain to them that you submitted the paperwork/info on time and you need them to make this right (either work w/ the insurance company to make it right or cover the expenses themselves). If you have been dealing w/ just an HR assistant I suggest you move up the ladder to the HR Manager or VP. Be nice and polite but firm and insistant. Have all the dates and fact necessary to support this situation. Once you have went to the top of HR, if this has not been resolved, you may want to go above that person to the head of the company.
2. Are the tests ones that can wait until March if the above does not work? I ask that because since you had coverage through Dec 31st and your pregnancy was covered, the new insurance will have to cover your pregnancy and not treat it as a "pre-existing" condition. If the above doesn't work and the tests can't wait, see what agencies in your area may be able to help during the next 2 months...Medicaid, state screening programs, the local midwives/OB/family planning clinics. In that same line, see what help they can offer you for your son (probably a form of state insurance or Medicaid). Act now, they should be able to make it retro active.
3. Contact your state's insurance commissioner's office and see if they can offer assistance in getting this issue taken care of for you.
Good luck.
This happened to a family member of mine (father in law) not pregnancy obviously. But due to an error at his work he too found himself w/out insurance. His company paid for his medical bills/prescriptions and all. So - just throwing that out there. He did not have to throw a fit, I don't think he even asked, they just did it.
If your hubby's company is at fault, I'd go to them and see what they can do to help you out.
Can you get Maternity insurance for the interim period or maybe qualify for emergency medi-cal?? I would try that first, then if all else fails- ask your doctor if they could pospone sending insurance claims/bills to the insurance co until your coverage is effective again?? I am soooo sorry this happened to you!
There has to be a way with your hubbys company that they can rectify the situation-- it was their fault----they need to find the solution. It is unacceptable to have to have you wait until MARCH! Thats unheard of! I would scream until someone hears you and does something about it--don't settle for their wait til march approach. You are high risk-you need to see the dr. Good luck!
M
I've worked in HR for 13 years. As long as you did your part, HR can fix this. Mom on the GO outlined it perfectly. You are going to have to make a "stink". Be polite, but insistent. Go directly to the top of HR. If they truly can't fix it with the insurance company, be willing to accept unconventional solutions such as them paying COBRA or your medical bills until March. Do not take no for an answer and get it in writing. I'm sorry this happened to you.
I used to work in the enrollment department for a medical insurance, and your husbands employer can appeal with the enrollment department and request that they review for retro enrollment. Since your husband did notify the insurance and his HR in a timely manner, it definitely sounds like you have grounds for an appeal. If your husband's HR uses a broker for their insurance, I would contact the broker directly and discuss the appeal option. Don't take no for an answer from the HR, make sure you get a supervisor or manager involved and I'm sure they can get this resolved!
Wow! This is a toughy! First, I would go to DH's company and read them the riot act. Nicely. Go to the HR boss and get some answers as to why the paperwork was not submitted on time and what the HR dept is going to do about it. Most likely, there is nothing you can do to get covered. I am sure a lawsuit can be filed, but it is really not worth the time and effort. It would take years to settle anyway.
Next, talk to the Drs. and see what can be done bill wise. They can negotiate their rates for everything. They have rates in place for insured and uninsured patients. Often, the uninsured, cash pre pay is significantly cheaper then insurance deductibles (I had my second son without insurance and it was cheaper than my first with insurance!!!!).
Last but not least, you can get on medicaid if you qualify. I would look into that. Not sure what it would cover, but make sure you get it all spelled out beforehand.
Best of luck to you!
It would depend on your income but it is worth checking into Medicaid through your local job and family services. good luck and I hope everything works out for you soon.
The baby should be covered under your state-provided insurance for the time being until your hubby's company gets things straightened out.
CHIPS will pay for your pregnancy which you can go ahead and apply for now while you fight it. It takes time to get CHIPS, but when it goes into affect it will be retroactive I believe, to cover what has already been done.
Does Texas have a program for mom's w/o insurance? I'd call social services and see if you qualify income wise. You may have to do a pay cash as you go type of thing. Social Services should be able to steer you into some direction. March is less than 2 mos away so don't worry too much it will be here before you know it. It's your 3rd pregnancy so you know the drill, just remain cautious and mindful of what you do for the next 7 weeks. Don't fret on the "what if's" since you are powerless right now. Chances are everything will be just fine unless you worry yourself into some sort of disaster. Do what you can to remain calm. I'd also talk to the HR dept a few more times because that is really just totally unprofessional, and in your situation you can file a grievance due to the fact that you are pregnant and it's a "hardship". They may make the necessary adustments for you. I would try that.
Ask how much it costs to pay out of pocket. We had to do this with our 2nd daughter who was born in 10/09 in Arizona, but it was much cheaper than we anticipated. I think it was $1800 for the dr, which included all prenatal visits, the delivery, and my postnatal checkup, and maybe $1650 for the hospital, which was for a 24 hour stay and vaginal delivery. They can also put you on a payment plan to pay it off. Good luck!
