My girlfriend might have lost her insurance, and we need help.
April 19, 2012 3:04 PM   Subscribe

AskMe: we need help. My girlfriend just found out that her health insurance was terminated for non-payment (she thought she had paid it, and when I get home this evening we'll double-check our accounts to see what happened.) Whether the error was hers or the insurance company's, the company has stated that it'll take them 10-14 days to know whether or not they can reinstate the plan regardless. She has a pre-existing condition (ADHD), so consistent coverage is very important - and Ms. MP is starting to freak out. What's our next move, and how do we get through this?

Some possibly pertinent details: her coverage with this plan began March 1, and it is a plan she is eligible for because she's a student in the CUNY system - the insurance company is Emblem Health/GHI.

This is what we really need to know:

* Is there anything we can do right now to make sure she's covered?

* Those 10-14 days cover a period where she was hoping to authorize a refill of her ADHD medication. How can we cover it in the interim?

* She's apparently been without coverage since April 1 - a time that includes a gynecologist appointment she had with the understanding it'd be entirely covered. What do we do with any resulting charges?

* What if, after 10-14 days, the insurance company declines to reinstate her?

There's also a personal/emotional side to this: the whole thing has been a real blow to my girlfriend's self-confidence in her ability to function as an adult, and she feels like a failure right now. (She's also currently on-edge at the prospect of telling her parents, who are helping subsidize her post-college education, about this, knowing there's a real strong possibility she forgot her monthly payment.) How can I best assure her that everything will be okay, she's absolutely not a failure, and she's not going to die alone and homeless either because of, or evidenced by, her being terminated from her health insurance plan? (Not me mocking her fear - that's something she's said she's genuinely feeling at the moment.)

Thank you, AskMe, in advance for your help - I absolutely know this is going to be okay in the end, but I think your advice and input will not only help us navigate the situation, but really comfort my girlfriend during a truly difficult moment.
posted by (The Rt Hon.) MP to Health & Fitness (8 answers total) 2 users marked this as a favorite
Since this is through CUNY, there should be someone in the department of student services that she can contact to help her out with this.

It is possible that once she's reinstated, she can apply for reimbursement of anything she's had to pay out of pocket during the uninsured period. All insurance plans I have ever had (none of which, admittedly, were GHI) have allowed this.

Can she talk to the ADHD meds prescribing doctor about getting some samples to tide her over? Is there a less expensive generic they can prescribe in the interim?
posted by elizardbits at 3:31 PM on April 19, 2012

I haven't had this exact problem, but I did have my health insurance terminated twice when my employer accidentally forgot to renew my position. Both times it was sorted out and my coverage came back without a problem. At least one of those times I paid for a prescription out of pocket, but I can't remember if I got it reimbursed after the fact. I would be pretty shocked if they did not reinstate her, but I suppose anything is possible.
posted by pombe at 3:38 PM on April 19, 2012

In the future, set up an automatic payment out of her bank account, so that she doesn't have to think about when to mail the check. Everyone messes up, but if you want to feel grown-up, figure out how not to make the same error again.
posted by Ideefixe at 3:50 PM on April 19, 2012 [2 favorites]

Read your policy. This just happened to a friend. Turns out they had 15 days to pay from the date of the termination letter, not the date of termination. Which meant they actually paid in time. They went through a greivance, were denied reinstatement, then had to point out to the insurance company the error, after which they were reinstated. So have someone who knows how to read their specific policy to make sure of the correct info. The insurance company should reinstate you as if there was no break in coverage.
posted by Vaike at 4:03 PM on April 19, 2012

If the coverage has just been terminated and it takes them a full two weeks to reinstate her, it looks like you may be okay under New York state law. IANAL and might be interpreting the information wrong, but it sounds identical to the way it works in my state, and I know all about North Carolina health insurance, let me tell you.

I've been in a similar position as your lady (right down to the terror at informing the parents and the "I will die crazy and alone"), and my sympathies are with her. It's incredibly hard to have to overcome your disorder in order to maintain treatment...for your disorder (I would link you to the blog post I stole that sentiment from, but it's been taken down). She IS NOT a failure. She is a person with an illness that makes it hard for her to do certain things. Her parents love her and want her to be healthy. You've got the gears in motion and this will get worked out. Now she has learned an important lesson about putting systems in place to overcome her illness. Ideefixe has the right idea--set up an automatic debit so that forgetting isn't a problem any more. Ta daaaaa! ADULTHOOD.
posted by Fui Non Sum at 4:03 PM on April 19, 2012

Response by poster: So, a few clarifications/questions:

- This insurance is *not* administered by CUNY - it's insurance the company deemed her eligible for *because* she's a CUNY student. As such, there's no one at CUNY to contact about this so far as we know, student services or otherwise.

- She doesn't currently have a primary care physician who is prescribing the medication - she had left her old PCP with her old insurance plan, and was in the process of setting up a new PCP, so there's no one to ask for generics at the moment. (The medicine is Adderall, btw - it's a controlled substance, so there's no such thing as a sample, and you need a prescription, of which doctors can only prescribe a month's worth at a time.)

- If this helps, we both live and work in Brooklyn.

Thank you for everyone for your help so far - the more information we can get on what to do now, and what to do if she's not reinstated, the better.
posted by (The Rt Hon.) MP at 5:00 PM on April 19, 2012

I read about the Attorney Generals health care help line in another recent health insurance askme.
Since then I've had two different friends tell me that they called the number and spoke to someone there and because of the attorney generals office efforts on their behalf was able to get a previously unresolvable situation resolved in their favor.
If you feel as if you're being wronged by the insurance company, this might be an option.
I would stress to your girlfriend that insurance companies do everything in their power to collect money from their customers and make it as difficult as possible for their customers to receive or continue to receive benefits.
A lot of very adult, very responsible people get caught in the insurance companies quagmire of very specific regulations and sometimes outright trickery (including myself at one point, and I own/run three separate businesses and employ dozens of people and am usually on the ball with these things); there's a reason there is an attorney generals contact number specifically for health insurance issues and not for most other industries.
posted by newpotato at 3:36 AM on April 20, 2012

The medicine is Adderall, btw - it's a controlled substance, so there's no such thing as a sample, and you need a prescription, of which doctors can only prescribe a month's worth at a time.)

Here in Los Angeles, my Dr. writes me three scripts at a time, post dated, which isn't illegal and is fine with him. She might ask her MD about this
posted by Ideefixe at 3:04 PM on April 22, 2012

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