New info demand from my health insurer
June 10, 2010 12:13 PM   Subscribe

My long-standing health insurer is making new information demands. Do I need to reply?

My health insurer of several years is now sending forms demanding information on any additional coverage from other sources, like Medicare or other insurers.

I see this as them looking for other organizations to shove costs onto, and I don't want that. When there's a covered expense, I want them to pay it without going through any rounds of corporate finger-pointing over which organization is responsible for the bill.

Also, responding may be unnecessary. There is no indication anywhere on the form or accompanying letter that not responding can or will result in any interruption of coverage. I think they're just fishing, likely because I have a family member with a very similar name who is eligible for Medicare, unlike me.

Finally, there is no other coverage, period. This makes responding with that information seem attractive, but I've heard plenty of stories of insurance companies using any trivial discrepancy in the paperwork to deny coverage, so I'm reluctant to supply any unnecessary paperwork.

Thus, despite the "Third and Final Notice" splashed across the letter and the "AUDIT DIVISION" mailing address on the return envelope, I'm not convinced any response is needed to maintain coverage or that it's in my or my family's interest for me to fill out and return the form.

Do I need to reply to keep my coverage?
posted by NortonDC to Work & Money (13 answers total)
Response by poster: I guess what it comes down to is that IF I don't need to respond to keep our coverage, then responding can ONLY have neutral or negative repercussions, and is therefore an unnecessary risk.
posted by NortonDC at 12:23 PM on June 10, 2010

Before an insurance company will pay a claim, they need to know if they are the primary, secondary, or some lower order of payor. I don't know why they are asking after several years of coverage, but it is a reasonable question. You may not need to answer to keep your coverage, but you definitely need to answer if you want them to pay the bills.
posted by SLC Mom at 12:29 PM on June 10, 2010

Response by poster: Thanks for responding, SLC Mom. That the company has been paying claims all along indicates that they know the information, at least to the threshold required to make payments, which is what matters to me. I don't know why they are fishing for a different answer now.
posted by NortonDC at 12:39 PM on June 10, 2010

This seems like the sort of notice the insurance company sends out to verify that there's no other insurance before they pay for something they're possibly not liable for.

Do you or your family have any bills that haven't been paid yet by the insurance company?

For instance, an auto accident may be covered by the auto coverage of the at-fault driver so your insurer can ask about that payment. Similarly if you have a claim that looks possibly work-related, they may be trying to ask you if you have work comp insurance.

You don't say if this is group coverage or individual. If it's group you could approach your HR rep or group rep and ask for help finding out what's up.

If it's individual coverage, you should probably think twice before throwing the letter away. In your policy's fine print there is probably a cancellation clause for 'failure to respond blah blah blah'.
posted by toastedbeagle at 12:40 PM on June 10, 2010

Best answer: I get these from our insurance company every year, or if there's anything pricey happening like a surgery. They want to make sure you're not double-dipping, and that if you have other insurance they can do coordination of benefits (what you call "corporate finger-pointing"). I think I get it because I am secondary on my partner's insurance and they want to make sure I'm not also insured by an employer on my own. I have found it hard to imagine how filling out the form and returning it could hurt me. My insurance company letter always says that they will stop processing claims unless they get the info by X date. I think I'd personally be a lot more worried that something bad would happen because I didn't fill out this particular form than because I did.

I don't think they're fishing for specific reasons. I think it's a pretty boiler-plate thing to do. They don't want to pay out like they're your primary insurance if indeed you have insurance from somebody else. Coordination of benefits is a pretty common and well-established thing. I have friends, for instance, whose kids are insured by both her job and her husband's, and from what little she's every said to me, it has only ever worked to their benefit (for instance, neither insurance paid 100% for her kids' braces, but between the two companies, they were fully covered and didn't cost her a cent).
posted by not that girl at 12:42 PM on June 10, 2010 [3 favorites]

I have to answer this question to our insurer every year. It's not a very big deal. I don't know if they can drop or deny coverage if you don't answer, but you may end up with more bureaucratic paperwork if you DON'T answer because then I assume they'd be asking every single claim.
posted by Eyebrows McGee at 12:42 PM on June 10, 2010

I get crap like this too, and have never answered. But that's only because it isn't relevant to me. I only have one insurer.

I bet that if you ARE covered by more than one insurer, there might be trouble if you didn't tell them.
posted by gjc at 1:52 PM on June 10, 2010

Call them. Tell them you've received the paperwork, and that you aren't covered by any other insurer, so is it necessary to send it back, or no?
posted by davejay at 2:17 PM on June 10, 2010

I've heard plenty of stories of insurance companies using any trivial discrepancy in the paperwork to deny coverage

As someone who works for a large private insurance company, I can tell you first hand that this will happen. Fill it out and send it back otherwise they very well could decide to deny your claims until they receive it back. It seems trivial, but they'll look for any excuse to not pay.
posted by ladybug_422 at 2:46 PM on June 10, 2010

Fill it out and return it. It's called a Coordination of Benefits letter and they will in fact hold up on paying any and all claims for you until you return it.

There is a specified filing order when it comes to people who have more than one insurance. It's not that they would be shoving responsibility onto someone else, it's that they need to know if there is any other insurance out there covering you that might be primary to them. That way they can pay accordingly. For example, if the insurance sending the letter is your coverage thru a spouse or partner, and you have your own insurance as well, your own is automatically primary. So your spouse's insurance needs to know that you have coverage that will pay before they will.

I don't know if they ever cancel policies for lack of a returned COB letter, but as someone who works in a hospital billing office, I know they sure do refuse to process claims until they receive it, or until you call and let them know if you have other insurance. They send these out because, in my cynical opinion, they use it as a sneaky way to not pay claims on people who don't or won't return it.

They may have been paying claims for you so far without it, but nothing stops them from auditing all previous claims they have processed in the past, determining that they should not have paid due to a lack of COB letter, and ask your providers to refund the money. Then when they do, the whole claim will be billed to you. So, I'd send it back.
posted by DrGirlfriend at 3:10 PM on June 10, 2010

I recently got the same kind of letter from Blue Cross, my only health insurer, after a small claim for a routine semi-annual dental visit. I've been insured with Blue Cross for more than 20 years, have had a number of claims (including cancer surgery), and have filed the same dental claim twice a year for years. At no time did Blue Cross ask if I had any other form of coverage.
posted by justcorbly at 4:18 PM on June 10, 2010

The reason that they ask after several years of coverage is that things may change. You may have gotten married, divorced, changed jobs, etc.
posted by yclipse at 4:20 PM on June 10, 2010

This is a pretty standard-sounding Coordination of Benefits letter. Our insurer sends them out every year. If you don't have any other coverage, then it should be a quick form to fill out. And yes, you should absolutely fill it out and return it, so that "missing paperwork" can't be used as an excuse to deny claims.

As to "fishing" -- well, in this economy, every insurance company is looking to cut costs, and one way to do it is to check all information that might affect coverage. Ours just demanded to see a certified copy of our marriage certificate. Intrusive? Yes, absolutely. Fishing? No.
posted by media_itoku at 3:31 PM on June 11, 2010

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