Dropped coverage by UHC and BCBS in spite of fully...

lammtita · ‎11-18-2019

Just wondering who is at fault and what recourse to take?

My husband went on COBRA, administered by IGOE, after I retired and went on Medicare. It's been a year and a half. His COBRA insurance carrier a year ago was UHC PPO. At the time, he had to call UHC and IGOE each month because UHC kept terminating his coverage every 30-days. His premium is paid monthly by auto-draft, so, no lapse in payment there.

This year, his COBRA insurance carrier was switched to BCBS PPO. The same thing happened in July and he got that straight. Suddenly, his coverage was terminated again in October and retroactively thru July - in spite of all the premium being paid. We'd spent so many hours on the phone with IGOE and BCBS. It's been a nightmare. Nobody seems to know what to do. BCBS transferred the calls to several different departments. Then, asked for documents. Can't they look up their own books and see that they have been collecting the insured's monthly premium? The insured needs his medications and go to his doctors for follow-up care.

Anyone experienced this before? What did you do? Who did you go to? I have a mind to suggest getting a lawyer to handle this but, lawyers cost tons more money. Any suggestions on how else to handle this?

Thank you.

GailL1 · ‎11-19-2019

@lammtita wrote:
Just wondering who is at fault and what recourse to take?

My husband went on COBRA, administered by IGOE, after I retired and went on Medicare. It's been a year and a half. His COBRA insurance carrier a year ago was UHC PPO. At the time, he had to call UHC and IGOE each month because UHC kept terminating his coverage every 30-days. His premium is paid monthly by auto-draft, so, no lapse in payment there.

This year, his COBRA insurance carrier was switched to BCBS PPO. The same thing happened in July and he got that straight. Suddenly, his coverage was terminated again in October and retroactively thru July - in spite of all the premium being paid. We'd spent so many hours on the phone with IGOE and BCBS. It's been a nightmare. Nobody seems to know what to do. BCBS transferred the calls to several different departments. Then, asked for documents. Can't they look up their own books and see that they have been collecting the insured's monthly premium? The insured needs his medications and go to his doctors for follow-up care.

Anyone experienced this before? What did you do? Who did you go to? I have a mind to suggest getting a lawyer to handle this but, lawyers cost tons more money. Any suggestions on how else to handle this?

Thank you.

Yep, there is a problem but I think more details are needed in order to figure out what is wrong.

There is more to keeping a plan than just paying the premiums - THE PERSON HAS TO ALSO BE ELIGIBLE FOR THE PLAN. Because of the way you desribe the constant cancellations/reinstatements, it sounds more like an eligibility problem.

A few questions to fine tune the details in hope to figuring out this puzzle.

Whose employment is this COBRA based on - your or husbands?
How old is your husband now - is he 65 years old yet?

If he is 65 years old (or older) OR he has been disabled for 24 months, he is eligible for Medicare and there are specific rules as to when COBRA will expire.

Now if that is not the case, it could be that the COBRA benefit is listed under your idenfying info, if you were the employee with the employer plan and when it gets checked, the insurer sees you are on Medicare and thus rejects the (his) eligibility - you may have to talk to your employer if this is the case.

Just a couple of links in case your husband is Medicare eligible.

AARP: COBRA and Medicare

International Federation of Employee Benefit Plans: Medicare and COBRA Coordination: What You Need t...

This link says . . . . but read the whole link because other info in the link may apply to the situation.

How Is Coverage for Dependents Affected?

An employee’s entitlement to Medicare is a COBRA-qualifying event for the spouse and dependents only. If the employee became entitled to Medicare less than 18 months before the qualifying event, COBRA coverage for the employee’s spouse and dependents is available for up to 36 months after the date the employee becomes entitled to Medicare.

If an employee elects COBRA and then becomes entitled to Medicare, the employee’s Medicare entitlement terminates COBRA early but this does not affect the COBRA rights of dependents as long as they are not entitled to Medicare themselves.

It's Always Something . . . . Roseanna Roseannadanna

LookinAround · ‎11-19-2019

I'd first complain to your State Insurance Department. They regulate all the insurance companies in your state and should attempt complaint resolution.

somarco · ‎11-21-2019

@LookinAround if the plan is self funded, the state DOI has no jurisdiction, no oversight.

Second, this does not appear to be a carrier problem, but rather an issue with the COBRA administrator. Again, no DOI jurisdiction, no direct oversight of admin's.

Bark less. Wag more.