Question
What is the name of your state? Ohio
We have a newborn daughter who just turned a month old yesterday. After trying to get ahold of Highmark Blue Cross/Blue Shield during the holidays (she was born 12/14/06), we finally reached them on 1/3/07 and were informed that we needed to contact my husband's HR department to get her added. They advised us that she was covered automatically for 31 days, but would be dropped after that if they werent notified to add her. We contacted the appropriate people and sent in the forms on 1/4/07 that they had emailed us. My daughter's 1 month birthday was yesterday, and as of today she is no longer covered. We have been trying to get to the bottom of this. His contact person at the site has assured us they sent the forms to the Corporate Office, not once but twice. He's talked to his supervisor, but everyone seems to be dragging their feet! What should we do from here? Is the insurance company obligated to add her even past the date? Who's responsible for her hospital bills that the insurance company did not pay? Is there anything else we can do to get this taken care of? We've done everything on our end, filled out the forms and got them back to them the next day, etc. all within the time limit. Is there any legal recourse stating they HAVE to add her? Thanks in advance for your help!
Dawn
Answer
After trying to get ahold of Highmark Blue Cross/Blue Shield during the holidays (she was born 12/14/06),
Why did you not begin trying to reach them on 12/15/06?
we finally reached them on 1/3/07 and were informed that we needed to contact my husband's HR department to get her added.
Which would have been a logical place to go when you couldn't get through to the insurance company.
We contacted the appropriate people and sent in the forms on 1/4/07 that they had emailed us.
What method did you use to send in the forms? Mail, fax, e-mail... And to whom did you send them? The insurance carrier or HR?
His contact person at the site has assured us they sent the forms to the Corporate Office, not once but twice.
Is the corporate office the right place to send them? Have you confirmed that?
Is the insurance company obligated to add her even past the date?
Not necessarily. In fact, if this is a Section 125 plan, they not only are not obligated to, they are prohibited from doing so by Federal law unless it can be proven that the forms were sent to the correct address before the expiration of the 31 day limit. However, if there is verifiable proof (which is why I am asking what method was used to submit the forms) that the insurance carrier received the forms before the expiration, then yes, they need to add her.
Who's responsible for her hospital bills that the insurance company did not pay?
You.
Is there anything else we can do to get this taken care of?
You need to be working with the HR department on this.
Is there any legal recourse stating they HAVE to add her?
Only as indicated above.
It's a little unclear to me where the forms were sent and when. If you can clarify this, I might be able to be of more help. This is something I have a lot of experience with, both from the insurance carrier and the HR sides of the desk.