Health insurance coverage terminated with no notice. What do I do?

November 4, 2017 10:24 AM

I just discovered that apparently my employer-provided health insurance was terminated and that coverage ended on 10/31. All premiums have been paid as normal (deducted automatically from paychecks, last one dated 10/27) and absolutely no notice of any form was provided to me. Any ideas how this happened, or what I do now, apart from waiting until Monday when the insurance company will actually be open and take my dang calls?

So yesterday I went to the doctor for this issue and got it sorted/got a prescription. Great! I went to the pharmacy this morning to fill the prescription and was told my coverage had ended on 10/31. NOT GREAT.

It's a weekend so obviously calling the insurer just gets me a recording telling me to call during their business hours. (Awesome customer service, guys.) I'm on my partner's employer-provided insurance, and no one in HR is around to answer our queries either, of course. I know for certain that my partner is definitely still employed, so it wasn't job-loss-related. My questions:

1) Can coverage be terminated with no notice? I suppose a letter of termination could conceivably still be in the mail, but we have online / paperless billing, and didn't get any message or alert on that system. We have been getting EOBs and health tips and all the other nonsense the insurer sends out emailed as normal, but no 'hey btw we cancelled your insurance' notice. (We checked the spam filters, too.) We logged in to the system and found on the 'member benefits' page that coverage ended 10/31, but no reason is listed.

2) What happens with medical bills incurred during this (evident) lapse? Am I financially liable for the full sans-insurance amount? I had no reason to think my coverage had lapsed when I saw the physician. I cannot afford to pay the full amount, and I can't afford legal representation, either, if that's likely going to be required. My partner also had a doctor's appointment yesterday, and therapy on 11/01. The EOB for the therapy appointment processed last night (at 3:17am) and is showing that we owe the full amount because coverage had ended.

3) If this has happened to you before, or if you know: provided our coverage starts up again, what happens with deductables and the like? Do they reset?

posted by halation to Health & Fitness (23 answers total)

Sorry, are you sure your coverage has been deliberately terminated, rather than the insurance company or your employer making some incredibly dumb mistake? The latter seems more likely than that your employer just up and decided to end coverage without telling anyone. Honestly, if it's the former, I'd be worried that my employer was on the brink of financial collapse and start looking around for new employment tout suite.

You can negotiate with doctors re: fees, but whether or not they get paid doesn't depend on whether you properly understood your insurance status, though. So I'd postpone any inessential appointments until you work out what's going on.
posted by praemunire at 10:46 AM on November 4, 2017 [9 favorites]

1) I don't know, and the whole thing sounds totally bizarre and wrong. You will find out more info on Monday. Hang tight. It sucks, but you can't do anything about it except maybe have your partner call a coworker at home and see if it's just y'all or if it's something bigger. Or maybe the company sent notice at your partner's work email instead of the email the insurance company uses to keep up with you.

2) If your termination from the insurance makes you eligible for Cobra, your coverage will be retroactive if you elect to continue paying for that insurance through Cobra out of pocket. You have a certain amount of time after you become eligible to elect to do that. I think it is something like 60 days or 63 days? Unsure. If you are not eligible for Cobra (that happened to me once when the entire company went under suddenly pre-ACA), then at least you would trigger the ability to sign up for a marketplace plan. This event corresponds so exactly with the Nov 1. opening of the marketplace, though, that I wonder if there's a relationship there.

3) No, deductibles do not reset until the end of the plan year, I am pretty sure, if you are continuing coverage of your old plan through Cobra. You will have the exact same coverage including end of benefits period as people who aren't paying it for themselves. But if you have to get a new marketplace plan, yes, it will be a new plan and therefore a new benefits period.

This sounds so stressful. I'm sorry.
posted by Stewriffic at 10:49 AM on November 4, 2017 [1 favorite]

I believe if your employer coverage is terminated for whatever reason, you are still eligible for COBRA. When I have had COBRA, the forms don't arrive immediately but the coverage is retroactive (meaning it does extend back ultimately there is no actual break in coverage). But if your partner is still employed and premiums have been paid, the whole thing sounds super strange and I am also wondering if it wasn't some type of weird mixup that will be corrected regardless.
posted by rainbowbrite at 10:50 AM on November 4, 2017 [6 favorites]

See if you can put it out of your head until Monday, because I suspect you will have enough more information then to start figuring out next steps. Deep breaths.
posted by Stewriffic at 10:52 AM on November 4, 2017 [5 favorites]

This happened to me. I discovered on a tax form that HR has made a mistake in my SSN. Fixing it with HR somehow kicked me off my health insurance. It was easily fixed once we figured out what happened and I had no gaps in my coverage, especially since I'd been paying my premiums the whole time. My guess is administrative error that will get sorted once you can talk to HR. It was very frustrating though as I found out when my doctor was verifying my benefits for an expensive surgery.
posted by carolr at 10:59 AM on November 4, 2017 [2 favorites]

That's just awful. There are lots of possible scenarios, and it will very likely work out. Bear in mind that every state has an Insurance Commission, they'll be part of the Attorney General's Department, and they may be useful if things get ugly.
posted by theora55 at 11:10 AM on November 4, 2017 [1 favorite]

I went to the pharmacy this morning to fill the prescription and was told my coverage had ended on 10/31.

Have you confirmed this from a second source? You ought to be able to log on to your account online and look at your coverage. It's also possible that your partner's employer changed the insurance company that they use and you still have coverage, just through someone else. Maybe contact another employee and ask if you missed a change? (That comes to mind for me because my employer changed insurance companies on 9/1, and I was too distracted being fleeing Hurricane Harvey flooding to notice until the next time I went to a doctor.)
posted by Pater Aletheias at 11:28 AM on November 4, 2017

The EOB for the therapy appointment processed last night (at 3:17am) and is showing that we owe the full amount because coverage had ended.


Oh, sorry, I missed this. Still worth checking to see if there might have been a change you missed.
posted by Pater Aletheias at 11:29 AM on November 4, 2017

I think you need to find out what the deal is on Monday. Right now, there's not much you can do until you know why. For instance, I've had my insurance terminated because I thought my automatic billing was going through but it wasn't, so my insurance was canceled for nonpayment. In that case you can pay to reinstate it, or re-enroll. Assuming whatever prescription you needed isn't something urgent and vital, wait until Monday and try not to panic.

As a side note, open enrollment for Oabamcare just started at healthcare.gov so if you need to get a plan there, you can take a look. (You have a qualifying event either way, but for the rest of AskMeFiers, just a heads up that open enrollment is happening now!)
posted by AppleTurnover at 11:30 AM on November 4, 2017 [2 favorites]

I've had this happen to me. I had been paying my premium every month, but found out my coverage had been terminated. I called HR and they sorted everything. It was a clerical error on their end. Once my coverage had been retroactively applied, my doctor resubmitted my claim.
posted by Ruki at 11:45 AM on November 4, 2017 [9 favorites]

As you go along write down who you speak with and any account numbers mentioned, saves time and increases your chances of gaining info from the calls and not retelling the tale to other customer service voices. I'd even record [only] my side of the exchanges, repeating answers you get out loud, just to make more sense if things go sideways.
posted by Freedomboy at 12:09 PM on November 4, 2017 [2 favorites]

Does the new plan year for your coverage usually start on November 1? (Most plan years start on January 1, in my experience, but there have been a few times where I've had coverage with plan years with different start dates.) If that's the case, then my money is also on administrative mix-up. (I mean, my money is on administrative mix-up anyway, but if your plan year starts on Nov. 1 then I think that's the place to start.)
posted by the return of the thin white sock at 12:10 PM on November 4, 2017

It is near open enrollment time, and my coverage switches on 12/1 NOT 1/1 like most people's.
Calling HR on Monday is the best bet, because they'll most likely know the answer on their end faster than your insurance can figure it out.

If it is a medication you absolutely need you may be able to get the pharmacy to allow you to buy enough doesages through Monday.

It could a clerical error where the number or name was miss typed and came back with a denial
posted by AlexiaSky at 12:14 PM on November 4, 2017

If you do get COBRA coverage I believe it will apply retroactively to things you've paid out of pocket for in the interim. (And as mentioned above you have like 2 months to sort it out, possibly 3 I think? But go with 2 just in case.)
posted by poffin boffin at 12:23 PM on November 4, 2017

Response by poster: open enrollment

This is a great point, actually. $EMPLOYER is changing health plan offerings for next year, and open enrollment for the new plans started 11/1 for coverage after the New Year. The insurance company is remaining the same, but fewer plan options are being offered, and our plan is one of the ones being phased out. We have to choose one of the new options by 11/17 or get defaulted to the bare-bones plan. So this could be a seriously dumb clerical error... and one entirely in keeping with my experience of insurance snafus. So that may well be it.

This is reassuring! Thank you! It's also reassuring to hear that people have had claims retroactively covered after similar issues. I've had my insurer-based coverage (with a different employer) terminated once before -- similar issue, where my employer messed up some paperwork and somehow cancelled literally everybody's insurance -- but I didn't see any providers during the week-long coverage gap and it was never made clear to me what would've happened if I had.

I'll still hold off on the prescription, though, just in case we don't get gap coverage. It's only a three-day course of meds but it still somehow costs $70 without insurance, so...
posted by halation at 12:42 PM on November 4, 2017 [1 favorite]

It might be nothing. You won't know until you start working on it, starting with your employer.

It happened to me. Blue Cross dropped my spouse from our joint policy, alleging that she "withdrew voluntarily", after the price of her treatment in a year exceeded the amount of the premiums in a year. That might be a coincidence. Fuckers.

She had a colonoscopy pre-approved by the insurance company scheduled in the week or two after we found out she had been dropped, and went through with it, while instantly getting onto the phone for hours a day to get it fixed. It's was an ACA policy bought on the California exchange, and they were involved in several conference calls.

It took months to get it fixed. We worked with the medical provider, and had them resubmit the bills that we had incurred, BUT NOT PAID, in the interim. We behaved just as if we were entitled to fucking policy that we paid for, that she had been illegally dropped from. We figured if we paid those bills, we'd never be reimbursed for them without getting a lawyer.

I don't think you can be dropped without notice, but you might not have received the notice yet. Talk to your employer on Monday, to find out what is what with them. After that, get on the phone with the insuror, get a case number, and start working them. Be patient and polite and persistent, and don't freak out. Take notes about every phone call, and every contact. Start a paper file at home, and never talk to them unless you have it at hand and are ready to use it. It sometimes took a few minutes for me to get into the right frame of mind before I made the necessary phone calls.

We prevailed. You will prevail.

The whole incident filled me with a black despair and deep rage that returns to me as I write this. I thought of the other people for whom this execrable tactic succeeded. We had to work to compensate for the foulness we were dealing with.
posted by the Real Dan at 12:43 PM on November 4, 2017 [3 favorites]

$EMPLOYER is changing health plan offerings for next year, and open enrollment for the new plans started 11/1 for coverage after the New Year.

Clearly, then, this is a clerical mistake, probably related to the re-enrollment process. Your employer is not canceling their health plan and the insurance company can not selectively cancel your coverage that's part of a group plan. Enjoy the rest of your weekend and straighten it out Monday.
posted by beagle at 12:55 PM on November 4, 2017 [2 favorites]

It seems likely that is an issue with the fact that coverage is renewing, though it could be that the company didn't pay the insurance carrier (see next paragraph). No matter the issue (renewal, clerical error, late payment), once it's fixed, there will be no gap in coverage--it will be fixed retroactively, and you'll be able to submit claims any covered services you received during the snafu period. Unless the company is cancelling insurance altogether as of 10/31 for some reason, there is no situation in which the insurance carrier's records will reflect that you weren't covered for a period of a few days/a couple weeks.

I do want to clarify the following, though, for you and anyone else reading: just because the employee-paid portion of the premiums have been deducted from paychecks doesn't mean the premiums were paid to the insurance carrier. In the vast majority of payroll/benefits setups (even integrated ones, managed by the same company), the deductions don't go straight from an employee's paycheck to the carrier--the deductions go to the employer, who then pays the premiums directly to the insurance carrier separately. And if the employer has failed to pay, or is very late on their payment, the insurance carrier will absolutely cancel the whole company's policy. The employer can usually reinstate the coverage if they pay within a certain grace period.

Source: In my professional life I help employers navigate this situation all the time.
posted by rhiannonstone at 1:32 PM on November 4, 2017 [4 favorites]

Prescription coverage is a mostly-separate thing from other health coverage. Some sort of bureaucratic snafu is plausible. I saw it happen a bunch of times as a pharmacy tech.

If you pay cash price for the prescription, and your Rx coverage is reinstated (that is, you have coverage for November again), your pharmacy should be able to re-bill the backdated claim and give you a refund for the difference.
posted by neckro23 at 2:18 PM on November 4, 2017 [1 favorite]

This happened to me too. Employer made changes for next years coverage and when open enrollment started, they mistakenly termed everyone in the company's coverage on enrollment day, not end of year. Chances are your partner will go into work Monday and already have a super apologetic email from HR in their inbox with an ETA on reestablished coverage. Costs during that lapse can be resubmitted, but you may need to call your provider and ask them to.
posted by fluttering hellfire at 2:38 PM on November 4, 2017 [1 favorite]

Unfortunately extremely common during annual enrollment. I work in employee benefits - lots of employers/HR teams struggle to provide data to the insurance carriers in a timely manner, which results in issues for the first ~week of coverage until the updated elections are loaded to the carrier's internal systems.
posted by Coffeemate at 2:55 PM on November 4, 2017 [2 favorites]

So yesterday I went to the doctor for this issue and got it sorted/got a prescription. Great! I went to the pharmacy this morning to fill the prescription and was told my coverage had ended on 10/31. NOT GREAT.

In reading this, it would seem to say that all went as expected, insurance wise, at the doctor.

Last month, I went to refill a prescription only to find the cost of the script to have doubled. In speaking to my insurer, it was discovered that my coverage had been put into a sort of "hold" (I forget the actual term they used. It was a fairly innocuous term.) Long story short, this hold primarily affected the prescription portion of my coverage. The CSR I spoke with could find no reason why my coverage had been dorked with like this and immediately lifted the hold.

All this is to say, your insurance may not actually be entirely cancelled. Stay hopeful.
posted by Thorzdad at 6:53 PM on November 4, 2017

This happened to my parents; just a glitch, but it was kind of an ordeal (maybe 2 months?) to straighten it all out with providers because their insurance company had terrible customer service.
posted by gatorae at 6:38 PM on November 5, 2017