Who can help me with COBRA and suspended AETNA insurance?

December 20, 2018 10:04 AM

My wife lost her job. We are paying for COBRA, which supposedly should continue our previous insurance setup with AETNA. However, we went to our pediatrician and they said our insurance status was "SUSPENDED." My wife has contact AETNA and they say our insurance is fine, but my wife got blood taken today and got the same "SUSPENDED" notice... Is there someone or some organization that I can ask for help? I live in Berkeley, California.
posted by mrgrimm to Health & Fitness (10 answers total)

You want what is called a "patient advocate" or "health advocate" who handles insurance and billing issues. I don't know who does that in your area but there is may be a nonprofit organization that provides some level of assistance and advocacy for free or low-cost.

California has an office of Patient Advocate but it looks as though they primarily take complaints and investigate rather than providing direct assistance.

You could call an organization like this one, the Center for Health Care Rights. They are based in Los Angeles but will probably know who is providing this advocacy in your area.
posted by gauche at 10:18 AM on December 20, 2018

Every state has an Insurance Commission, part of the Attorney General's Office. They may be able to help. Try this site. My current insurer is awful. I ended up posting to their facebook page and got an answer.
posted by theora55 at 10:18 AM on December 20, 2018

Your wife should check in with whoever at her old job manages COBRA administration.
posted by ThePinkSuperhero at 10:19 AM on December 20, 2018 [6 favorites]

For Cobra, yes, she should try her old job first.

Also try, The Health Consumer Alliance.
posted by inevitability at 10:38 AM on December 20, 2018 [1 favorite]

This happened to me in another state, and I called HR at my previous employer. They sorted it out and all was well. And it didn't take more than a day.
posted by citygirl at 10:40 AM on December 20, 2018

Who did your wife contact at AETNA? Give that contact number to your health provider.
posted by Grumpy old geek at 12:17 PM on December 20, 2018

When I paid for COBRA coverage, there were a few weeks where the insurance showed as inactive. I had to pay out of pocket for a bunch of stuff and then submit claims for reimbursement. Annoying, but they were able to verify that I had paid the whole time and my insurance just wasn't quick enough to re-update the status so that doctors were able to submit claims.
posted by rachaelfaith at 12:42 PM on December 20, 2018 [3 favorites]

Because COBRA is retroactive to the day after the qualifying event (which was the day your wife's employment terminated) but you have several weeks to actually elect COBRA, some plans will wait to see if you elect COBRA before paying claims submitted before the enrollment materials would be due. By law, COBRA coverage must be reinstated back to the day after her termination, so you will ultimately have no break in coverage.
posted by Pax at 7:34 AM on December 21, 2018

Been through this. You and your wife should immediately contact her old HR people that handle COBRA. It is all done through them, not the provider.
posted by Chitownfats at 9:48 AM on December 21, 2018

Yes, contact her old HR people. When I had an issue like this at my (then new) job with my health insurance (it had just become active, I had confirmed it and gotten a copy of my card, but when I went to the pharmacy they said the insurance company had no record of me) I went to my HR people and they straightened it out for me pronto. Your wife is still on their insurance, so they're still responsible for handling this kind of thing. Definitely try them.
posted by Anticipation Of A New Lover's Arrival, The at 7:23 PM on December 21, 2018