COBRA admin says they paid health insurance carrier, carrier says no

November 5, 2021 8:47 AM

What to do when the COBRA admin says they paid your health insurance carrier, and your health insurance carrier says they didn't, and so you're not covered? Twist: Suddenly on the way to the ER

I am on a COBRA plan which is fully paid, according to the administrator, through February. However, my health insurance carrier – United Health – is saying that my plan expired at the end of September.

I thought I had more time to resolve this, but as of an hour ago, it looks like my son will be on his way to the emergency room for some symptoms he's having (not Covid, possibly appendicitis).

I just called the health insurance administrator who says they submitted an "urgent update" (which takes 3 - 5 business days to take effect). They also say it can be resolved by phone, but they "can't call" the plan administrator. And the plan administrator "can't call" the insurance carrier.

I'm worried about the timing of the resolution, but I'm also worried that, if the 3 - 5 day "urgent update" doesn't happen, that I have no way to fix this.

Any advice?

posted by thumpasor to Grab Bag (9 answers total)

Response by poster: This is in the United States, sorry for not mentioning that in the question.
posted by thumpasor at 8:48 AM on November 5, 2021

Best answer: Sorry to hear you are dealing with this. My suggestion is - do not pay any bills - ask the hospital to bill your insurance card with the subscriber number. If the bills do not go through - then send the bills to your plan administrator. You have done nothing wrong, it is the administrator and insurance co that need to play catch up.

If at all possible avoid paying a full bill out of pocket and applying for reimbursement. That is a much more difficult process.

My guess is the plan administrator did not send the payments in time or messed up the transfer of your benefits from employed and enrolled to not employed and still enrolled on COBRA.

The good news is - if United Health has you as canceled, but the plan administrator gets their act together and re-enrolls you, they can re-enroll you back-dated to the start date of your COBRA election. That start date should be the day after your end of employment, meaning you have no lack of coverage.

Once United has you back on as a subscriber - then your job is to call the ER, hospital, any Dr or lab bills that have gone unpaid - and very nicely ask them to re-submit the bills to insurance. Then United will process the claims properly. You will still get billed for deductible or co-pay, but the insurance will be in effect.

Things to look out for - if the start date is later than your departure date, or the plan administrator re-enrolls you with a gap in coverage - it might work short term for this ER visit but they are cheating your out of the COBRA premiums you paid for.

My experience - I am a plan adminstrator at my job in the US and I have dealt with employees transferring and leaving employment but staying on COBRA.
posted by sol at 9:08 AM on November 5, 2021 [24 favorites]

From what you've said here, I would be pretty confident you are covered for today's hospital trip, though you may need to have the same charges submitted multiple times in the next couple weeks. Your administrator says you have paid, you have made your payments, and in about a week the insurance system should be updated to show your continuing coverage from the end of September. (I am not an expert but I am HR for a small office and deal with the insurance.)

on preview, what sol said. Hope your ER wait is not too long, and your son recovers swiftly!
posted by Glinn at 9:11 AM on November 5, 2021

If you paid the premiums, you should be able to sort it out and get enrolled retroactively. It should be even easier if the health insurance carrier's statement that your plan expired at the end of September means that your job ended in September, because then you likely are stillwithin the period you have to decide whether to elect COBRA coverage. You should have at least 60 days to elect COBRA, and COBRA coverage can always be retroactive to the beginning of the period even if you pay later (or, in this case, it should give you time to sort out that they were already paid). This website has some basic information about how COBRA works, which will hopefully put you more at ease during this stressful situation!

On preview, sol's advice is good. Good luck, and I'm sorry you're dealing with this.
posted by alligatorpear at 9:12 AM on November 5, 2021

Set up a three way call with you, the COBRA admin, and the carrier. Let them figure it out between them. Since you're on the line, you can give the needed permission for them to talk and share info.
posted by ananci at 11:49 AM on November 5, 2021

Seconding ananci - they can't call each other but you can act as the switchboard. If the COBRA administrator is easier to reach by phone, I would start with the insurance carrier and then have them stay with you on the line as you conference in the administrator and then let them figure out what needs to be done next.
posted by metahawk at 12:08 PM on November 5, 2021

Best answer: sol is correct. This will get worked out one way or another. Insurers give themselves basically infinity on this kind of stuff. Absolutely do not pay any bills or attempt to find alternate coverage.
posted by ThePinkSuperhero at 7:34 PM on November 5, 2021

Response by poster: Thanks everyone! And especially sol, that answer was comforting.
posted by thumpasor at 9:21 AM on November 6, 2021

Also, depending on the timing of the various events, it's likely that you have until 60 days after the "Outbreak Period" ends (which it hasn't) or one year from the triggering event (the event in this case being a failure to pay premiums, if that actually happened) to pay your premiums under IRS guidance: https://www.irs.gov/pub/irs-drop/n-21-58.pdf.
posted by Pax at 11:42 AM on November 6, 2021