Question
What is the name of your state? CO
I am 8-month pregnant and I got a letter yesterday that my COBRA was terminated on 02/28/05. I consider that there is miscommunication when CONEXIS, my COBRA organization, sent out the premium coupon to me. The cancellation is so sudden and without much of notice.
I am trying to appeal. I am also trying to find other options. But I found that I am like deserted by the whole world.
I am 30 years old and healthy. I probably have one or two doctor visits a year for flu. I had no surgery or ever been hospitalized in my life. But I am always covered under very good insurance and contribute to the insurance pool religiously. Under COBRA, we’ve paid our six hundred dollar payment monthly and continuously. I have an excellent pregnancy so far, even as a pregnant woman, I probably utilize the least insurance a pregnant woman could utilize.
When I most need my insurance the first time in my life, this happens to me. Can somebody please help me?
Thanks in adavance
CLL
Answer
Two questions:
1.) Did the letter say WHY your COBRA was terminated? If so, what was the reason?
2.) How long have you been on COBRA?
The answers to both questions are needed before anyone can provide you with any options.
Answer
I am very lucky that my problem is resolved. I want to share my experience and hopefully my message will help people who is experiencing situation like mine.
My Story:
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I am almost 8-month pregnant and I got a letter 2 days ago from my COBRA organization, CONEXIS, and stated that my coverage was terminated on 02/28/05. I was extremely shocked. I left my last job and started using COBRA Octorbor last year.
What happened is that, in February 2005, I received two letters from CONEXIS. The first one includes the new payment coupons for 2005. The 2nd letter stated that “Due to an internal error your 2005 coverage coupons were not generated. Therefore, we are allowing an additional 30 day grace period to bring your account current. You have until 3/15/2005 to have your payment postmarked. You will be receiving coupons shortly…….”
Since I received the coupons prior to the 2nd letter which stated that I "will be" receiving coupons. Somehow my poor English comprehension lead me to the assumption that the coupons I received prior should be discarded and I "will be" waiting for new coupons. However, the new coupons never arrived and I totally forgot about it.
Two month later which was 2 days ago, I received the next letter from CONEXIS and it informed me that my insurance was terminated on 02/28/05.
At first I thought we missed payments. After I talked to CONEXIS, I realized that we really didn't miss one single payment. We use direct pay from bank which cuts check automatically every month. It is my misunderstanding of the two letters back in February leads to a deficit on our payment. CONEXIS, in my opinion, terminated my coverage without a clear notice.
I am not trying to say that there is no fault on my part. However, for all the insurance I've joined, we get notice many times before a policy is terminated. Take GEICO, the car insurance for example, they would send out quite a few warnings with pink envelopes and the deficit would be stated clearly in the statement so I know exactly how much to supplment the deficit.
In our case with CONEXIS, however, the message was very brief, plus how much deficit we should pay was not stated.
I didn't realize at first what kind of horrible situation I was in. When I called around yesterday, I found that pregnancy is considered as a "pre-existing condition" and no insurance company would accept me.
Secondly, because CONEXIS didn't notice me untill a month and half after they terminate my coverage, we might already exceed the 30-day breaking time to switch to other options. For example, to be accepted by my husband's new employer.
I am 30 years old and healthy. I probably have one or two doctor visits a year for flu. I had no surgery or ever been hospitalized in my life. But I am always covered under very good insurance and contribute to the insurance pool religiously. I have an excellent pregnancy so far, even as a pregnant woman, I probably utilize the least insurance a pregnant woman could utilize.
Yet, when the first time I most need a health insurance in my life, I was denied and deserted. I was very devastated.
My Actions:
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1. Made phone calls to the COBRA organization, in my case, CONEXIS. You might encounter a few unhelpful representatives before you finally find a helpful one. You might need to inisist on talking to a manager so you can squeese out more helpful information. You might need to repeat a question many times since each question might have 3 different eligible answers. But most likely, they would only tell you one at a time. You would need to ask a question many times to ensure there is no other alternatives.
In my case, I finally knew that I could file an appeal to the appeal department by email. And I did immediately.
2. Call the insurance company, in my case, United Health Care. If you don't have a "pre-exisiting condition" like me, you might be able to get an indivisual plan through the health insurance company directly. Compare with COBRA, you might even find a cheaper alternative.
3. Call the HR of your formal employeer. Since they are the payer to the COBRA organization, if you have an eligible situation, they can better press the COBRA oragaanization to reinstate coverage.
4. Call or write an article to news station. Many local news station may have a consumer help line.
5. Since it is COBRA, call US Department of Labor. 1-866-275-7922 I found their benefit advisors had been extremely frinedly and helpful.
6. Try State Insurance Commissioner. In my case, though the advisor was friendly, he couldn't really help me. COBRA is under federal control.
7. Call lawyers and post your situation on forum like this.
8. Call state insurance pool. This would be my last back-up plan if no body would accept me. But it is extremely important to call them and find out early if you can be qualified for this option. It can take days, if not weeks, for you to figure out and wait for the results of all the above options. And you don't want to miss your breaking time.
This is a very long message, but I hope my experience will be able to help someone in the future..... I really appreciate the fact that my problem is resolved and all the help from people from the above options.
CLL
Answer
I'm glad it worked out for you but I want to just point out one thing, not only for your benefit but for the others you are posting to.
Your employer has NO obligation to provide you with coupons, notices, reminders or anything else of the kind. Many do but that is a courtesy, not anything they are obligated to do by law. It is YOUR responsibility and no one else's, to know when the payments are due and to send them in a timely fashion, regardless of whether you have a coupon or a reminder or anything else.
Answer
I think in my case, maybe the problem was resolved because they didn't notify me the deficiency.
" If the amount of the payment made to the plan is made in error but is not significantly less than the amount due, the plan is required to notify you of the deficiency and grand a reasonable period (for this purpose, 30 days is considered reasonable) to pay the difference. The plan is not obligated to send monthly premium notices. "