Cobra termination

April 18, 2008 9:41 AM

I missed a Cobra Payment and they terminated me. How can I appeal their decision?

I screwed up, got confused and missed a COBRA payment. They have terminated me as of Feb 29. They tell me that I can write an appeal letter. This will take fourteen days. Can anybody give me some advise as to what to say int the appeal letter?

If it makes a difference, I have bipolar disorder, and have recieved disability. I believe I am still officially disabled.

If I cannot get COBRA back, do I have any other options? My pre-existing condition (bipolar disorder) makes it impossible to buy regular insurance. Now that I have been cancelled due to non-payment, I no longer qualify for HIPAA. What are my options?

posted by TigerCrane to law & government (4 comments total)

I don't think bringing your disorder into play is the wisest choice here. Rather you should just stick to the cold facts and clearly communicate that you do not wish for them to construe your missed payment as a desire on your part to terminate your COBRA coverage. Did you later send any late payments that were returned to you by the insurance company? When did you find out your coverage had been ended? You don't say exactly what the screwup was but I imagine your best bet is something short, sweet and to the point, e.g.:

Dear Insurance Company,

This letter is to appeal the termination of my COBRA coverage which ended Feb 29. Through fault of my own I failed to send payment for March 2008 by the payment deadline. However, it was not my intention that this late payment be interpreted as a notice that I wished to discontinue my coverage. I would appreciate consideration that you reinstate my COBRA coverage back dated to March 1, and if this appeal is accepted I will remit payments equal to the cost of coverage through the end of (April or May). Thank you for considering my request.
posted by contessa at 11:46 AM on April 18, 2008

This booklet (warning: .pdf file), while not binding legal authority, sets forth the requirements of a COBRA plan. It suggests that you are entitled to a 30 day grace period during which you may catch up a missed payment. The provisions I am discussing are found on pages 17 and 18 of the booklet.

The federal statute makes it pretty clear you have a grace period as well.

It is not entirely clear from your question whether or not you are still within your 30 days, so contact them as soon as possible.

COBRA is really nothing more than insurance coverage mandated by law. In a perfect world, the Department of Labor would police the insurers and enforce provisions on behalf of the little guy, but I doubt you could get any assistance from them. You might get some assistance from your state insurance commissioner's office. Where I am, they have a consumer's division that can help with these kinds of issues.

I am a lawyer, but I am not your lawyer, etc.
posted by pasici at 12:54 PM on April 18, 2008

Well, if they terminated you as of Feb. 29, it sounds like the grace period's no longer an issue.

And, from my own experience with COBRA, insurance companies HATE, HATE, HATE it. They love to terminate COBRA customers, and are highly unlikely to cut you any slack if they don't have to.

(It's not entirely clear to me why this should be the case. They're getting the same exact amount of money they used to quite happily accept to insure you when you were employed. It's just all coming from you now. I can only assume that it's more of a bother to administer than a massive corporate account.)

So yeah, send the appeal letter and Contessa's looks like a good example (I agree, don't ever go out of your way to point out the impact of a health problem to an insurance company). But I doubt it will work. Honestly, if your health is going to be a concern to you, and I'd say the same thing to anyone who's not one of those "never been sick, never go to the doctor" kind of people, you should seriously look at getting out of the US.

If you get another job, presumably you'll get some kind of coverage, but now you have a pre-existing condition. There will be exclusions and waiting periods and a powerful company with a strong financial incentive to refuse you care. Obviously, you can't just get on a plane and go, but in all seriousness, start making plans because it's never going to stop. And it doesn't have to be that way.
posted by Naberius at 8:24 PM on April 18, 2008

And, from my own experience with COBRA, insurance companies HATE, HATE, HATE it. They love to terminate COBRA customers, and are highly unlikely to cut you any slack if they don't have to.

The insurance company didn't terminate the poster as they never handle COBRA eligibility. Your former employer or their COBRA administrator did. The insurance company just processes the term (in face, the insurance company almost certainly has no idea that the person is no longer an active employee).

(It's not entirely clear to me why this should be the case. They're getting the same exact amount of money they used to quite happily accept to insure you when you were employed. It's just all coming from you now. I can only assume that it's more of a bother to administer than a massive corporate account.)

Why the administrator or former employer terminated the poster on the first possible date is because that's the way COBRA is administered. In general, people covered under COBRA are a worse risk. People with known minimal health expenses often don't bother with COBRA.
posted by MarkAnd at 8:30 AM on April 25, 2008