Dropped from Insurance - 6 weeks before baby

You have taken steps and I think you have responded rationally. These insurance companies may have time but they can not twist and bend the rules as they like. It is a mindgame they play. Please be strong and believe in your rights.

OMG! Sounds to me like a not-so-subtle case of “get rid of that expensive diabetic” discrimination! Just reading this first page of comments gets me HOT under the collar. By all means, file a complaint with your Insurance Commissioner. (I used to work for the local office of the National Assn. of Insurance Commissioners and do recall that much!!)

Good luck!

Lois

Thank you so much, friends, for your feedback.

Those of you who suggest trying to ask HR to step in on our behalf…that’s the problem. This is actually NOT the insurance company taking this action - we called them and they have yet to be notified that my coverage was cancelled and they continue to pay on claims without any hiccup (I just received word today that three more claims have been processed and paid).

This is exclusively the jurisdiction of our HR people. It is HR whom we call and argue with. This company is “self-insured.” We were given 2 or 3 different insurance companies to choose from, but the ultimate decisions about my coverage lie with the employer. My insurance plan might approve or deny a certain treatment, for instance, but if our employer’s plan states that we are or aren’t covered for something, that actually trumps the insurer’s decision.

Because it’s HR, I’m not sure how the state insurance commission may step in, but I intend to find out. Thanks for the tips there, folks.

Ok Mel, I have the same type of insurance, It is called an ERISA plan and is regulated by the US Department of Labor… Here are the DOL links for Texas

Like a lot of HR departments they would sell the employees soul to maintain profitability at any cost.

Ohhh their sacred rules… I have fought too with them when I was working. Hang tough. Sounds like your insurance commissioner may be able to help.

We just went through this at my husband’s employer as well. They however did bring much attention to this “insurance audit” and were not cancelled. I however had a fit about the lack of concern for our privacy. We were forced to mail copies of marriage license, birth certificates, tax return complete with social security numbers in a postage paid envelope to hr. No security involved. All our private info out there for an identity theif to get a hold of so easily.

Many of my patients have gone through these as well lately. Supposedly to catch people still covering ex-spouses, or kids they don’t really have custody for??? I think it is just another way to possibly aggravate and save a buck. I’ve seen too much of it lately to believe they are necessarily singling you out as expensive, but they have to provide you with more warning than one lousy notice.

Good luck, I didn’t want to be so cooperative, but when they threatened us with the back claims on this year when my son was diagnosed, I had no choice.

Please try not to get to upset for the sake of you and your baby. You will be in my prayers

Michele

I think you have a lawsuit! Produce your marriage certificate, and see if that works. Consult a lawyer!

And you wonder why the Insurance Industry in this country is F@#D up this is tantamount to criminal behavior and there is no oversight at all, I feel for you and you should appeal to anyone and everyone you know, I would go as far as the media because the threat of bad PR is the only thing these guys are scared of.

Hey Melissa, i hope things work out. We had to do the proof of marriage thing too … for the first time after 36 yrs of marriage. Sometimes I do think they target the people with the costly claims. Hang in there and try to stay relaxed at least for baby’s sake. I wish you well. Good luck with the baby.

OMG Melissa! I never experienced that, but I had my children long ago and was married several years before I had children. I can tell you now that I have been denied coverage just recently, and I believe it’s a scam in this industry to penalize diabetics. Your state should have an insurance commission that you can file a complaint with. I wish soooo much luck. Please keep us posted, and if there’s anything I can do to support you, don’t hesitate to ask. This should anger ALL of us!

I am so sorry Melissa…they will have to make right on this…I cannot imagine how this could have been cause for an interruption in your coverage. Many here have echoed the same sentiments…provide documentation and if they do not correct the error…let them know you are getting a lawyer. I think cost of care and loop holes in the law are resulting in a rash of these employer/insurance actions to purge those covered. Good luck to you…and let us all know if there is anything we can do to help you. Hugs and take care of you and the baby:)

It sounds like the insurance company has it in for you and your family but I know you will overcome. Appeal and also get in touch with your state insurance commission. Keep up the good fight Melissa.

Melissa:

I have not encountered this, but I have some speculation. First, we can expect that as the new health care bill gets closer, situations like these will be more common. It is not a good explanation, but, I sounds like what I might expect. Second, the period issue of the marriage certificate and all is more than just BS. I would give htis four days and contact an attorney. I suspect they will back down quickly if an attorney enters the picture. In the mean time I would file a complaint with the state attorney general. I would do that over the weekend, and let them know you have and are contemplating an attorney. These steps will up the antii in this fight, and do not be afraid to use it .

A couple of ideas, here. First, i would secure a copy of the plan documents. Your employer will have these and send the husband to the personnel office right away. If the husband is not able to go, you go. Once you get these document read them cover to cover, you will know more about them them most and no matter what else, it will give you something productive to do while you are pressing ahead. Second,challenge, the insurance company for receipts that indicate they sent you notices with return receipt. This is not a requirement, under federal law, but that will also cause the company to rethink what they are claiming. In doing these things, maintain your tactic of saying you did not receive any such notices. Since i do not know your company I am guessing, but I bet they cannot provide proof of service on your notice. Finally, and this is important, your husband should attempt to enlist your company in the fight. Your quickest way through this is for your company to join the fight. They may do this if your husband can get to his benefit person and let them knwo what is going on. If your company is against you, this will go to court, if they are for you, it will be fixed and an attorney will not be needed. So, race there and tell your side, you can bet, the insurance company has already talked to them and the insurance company has tacit approval to go forward with their move to tighten eligibilty, however, the company will really not want to have this sort of fight going on.

To everyone who is reading this post. When an insurance company send you something for a response, call the company immediately and then supply the information they are requesting. In this period before the new health care proposal goes into effect companies will likely be looking to rid themselves of risk. Diabetics are generally thought of by insurance companies as a bad risk.

rick phillips

Hi everyone

From Melissa’s description of the plan it is an ERISA plan and therefore NOT covered by state law, the state insurance commissioner won’t even look at it. ERISA plans are covered by Benefits Security Administration (EBSA), a division of the U.S. Department of Labor (DOL)

Sounds suspicious to me. I’d say it’s a BS technicality and they’re doing the same thing they did to me - denying in the hope you won’t appeal so they don’t have to pay. Stick it to them - lawyer up, and get all your documents in order to show they don’t have a leg to stand on.

I’m so sorry! I hope you win in an appeal.

Our company in a money crunch, just did the same thing. They called it an audit, and everyone had to resubmit documents or face “prosecution and loss of job”. They were very clear and very good about making sure everyone knew what was going on. We are all having to now participate in all kinds of “wellness” programs and coaching deadlines or they will not subsidize us. I am also required to be in chronic disease management program. It seems like they are trying to weed us out on technicalities. I mean how many hoops do we have to jump through…

all i have to say is OH MY GOSH!! GOOD LUCK!! …i know this post was a month ago, but i hope things are working themselves out…WOW!!