Down The Drain
March 13, 2007 3:58 PM   Subscribe

Switching health insurance - any way to get a prorated reimbusment?

When I first enrolled in my graduate school program last fall, I was given the choice of signing up for the University's plan or a plan administered by a national graduate student organization. Without doing much research, I stupidly opted for the latter, because it was slightly cheaper.

I haven't seen a doctor or used the insurance at all, until last week I decided I needed to visit a physical therapist. Well, as it turns out, these types of visits aren't covered by the national plan, but are by the school's plan (after a doctor's prescription). So I've decided to switch insurance company's in mid-stream, because seeing a PT is something I will likely do a fair amount (I'm injury prone).

So I signed up for the school's plan this week, and paid a prorated amount for the rest of the semester and through the summer. I was told that I would have to drop the old insurance within a month to complete the switch, which is fine by me, since the new plan really does cover all the bases that the older plan does.

Here's the point: I then asked the company from which I was switching if I would be able to get a prorated reiumbursment, to which I was given the expected "no!" So, I'm paying half a year's worth of insurance (500 bucksish) down the drain.

Do I have any recourse? Any tips on how I could possibly recoup this money?
posted by jtajta to Work & Money (6 answers total)
Everything is going to be based on the date of your physical therapy appointment. The University plan didn't know you from Adam on that date, so unfortunately there's no reason for them do anything other than deny that claim. To do otherwise would be to set a sincerely reckless precedent.

It might help to remember that insurance is not an all-you-can-eat buffet. You are not trying to beat the house. Insurance is a hedge against the possibility of your needing medical care that you can't afford. Don't look at the money you spent on the grad student plan as "down the drain," think of it as money well-spent to avoid exposure to catastrophic health care costs. That you didn't experience any catastrophic costs is beside the point.
posted by deadfather at 6:19 PM on March 13, 2007

Response by poster: I may not have explained myself clearly.
I'm not looking to get the PT appointment reimbursed, I'm looking to recoup the remaining six months worth of insurance (that I signed up for and paid for) from the plan I just switched away from.

As per your second paragraph, I agree. I don't regret having insurance for the past three months, even though it never kicked in (thankfully). What I regret is that I can't get out of my old insurance policy early and get reimbursed once I drop it. That - the next sixth months that I've payed but won't be covered for - is money down the drain.

Oh well...
posted by jtajta at 9:05 PM on March 13, 2007

First off, to make it crystal clear to whomever you talk to on this quest, you want a refund of your premium for unused coverage. Not a "reimbursement," which is a loaded term in health insurance.

Second, read your contract with the insurer closely to see if there is an out.

Third, call your state insurance department and ask if there are any laws or rules regulating policy cancellations. With something as regulated as health insurance, it would not surprise me if there's a requirement that it be cancellable given a certain notice period, in which case you could get a refund.
posted by backupjesus at 9:15 PM on March 13, 2007

Ah ... sorry for the misunderstanding. If they are terminating your coverage before it was scheduled to end, then yes, you are entitled to a pro-rated refund of your premium. Raise polite but holy hell until you get it. This is not an health insurance issue--if it came down to it, you could sue them for breach of contract.

If, however, they are simply refusing to terminate your coverage early and keeping your full premium, then they are technically within their rights. Still, I would raise polite but holy hell. If at all possible, speak with the appropriate Human Resources staff at your university and get them on your side--they have leverage at the insurance companies and often that's all it takes to get problems resolved. If that doesn't work, escalate, escalate, escalate. Document your conversations with the insurance companies and note all inconsistencies and rude behavior--this can be used as ammunition for your last resort: a polite but firm letter to the CEO.
posted by deadfather at 9:25 PM on March 13, 2007

And reading backupjesus, I may be missing a pertinent state law (or lack thereof) which allows evil insurance companies to keep your money. That would make regular Jesus cry, but it might be true.

Still, polite but holy hell.
posted by deadfather at 9:28 PM on March 13, 2007

Response by poster: Thanks for the advice - I'll get tough!
posted by jtajta at 9:49 PM on March 13, 2007

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