Question
What is the name of your state?What is the name of your state?What is the name of your state?What is the name of your state? Florida, but the company I work for is in Nevada.
My wife was covered through the insurance plan provided by my employer. We were making co-payments and everything was fine. We had our baby via emergency c-section and have a healthy baby boy.
The problem is that my employer cancelled our health insurance, for financial reasons, fully one month before we found out about the cancellation. The first we heard about it was when we were in for a new baby checkup and they informed us that the insurance company would not cover the visit.
During that month of no coverage we had the most expensive part of the pregnancy -- the delivery. Consequently, we have an immediately due debt of over $21,000.
Had we known that we were not covered we would have made other arrangements.
The employer told us that even though the coverage was cancelled the insurance company would have to cover the entire pregnancy since they covered the first part of it.
Is this true?
Answer
Not under the law. It is possible that the insurance policy itself provides such protection, but the law does not dictate that the insurance pay for anything beyond the date of cancellation.
Answer
Thanks for the timely response.
What complicates this is that the employer is completely convinced that it is a federal requirement that insurance companies cover the entire pregnancy if they cover any of it. Can you point me to any statutes or legal references that I may take to him to tell him (in a nice way) that he may be (is) wrong?
I'm trying to keep the interaction with my employer as friendly as possible at this point.
Answer
Unfortunately I cannot; the reason being that you're going at it from the wrong end. It's not that there is a statute saying that they don't have to pay; it's that there ISN'T a statute saying that they do.
Barring a clause in the policy that they will cover the entire pregnancy regardless of the cancellation date (and it is not impossible that there is one; such clauses are not unheard of) they have no liability for anything beyond the date of cancellation.
A couple of possibilities:
1.) When I've had an employee that tries to tell me that the law says thus and so, instead of trying to prove him wrong I've had some luck trying to get him to do the job himself. You might want to try something on the order of the following: "Please, Mr. Employer, can you show me the statute that says the insurance company has to pay for the entire pregnancy, so I can show it to the insurance company and force them to pay?" While I don't think this is the case, I've been out of the insurance field for several years; I suppose it's barely possible that such a law has been signed. I don't think so, though, because even if I've been out of the insurance industry, I've been in HR all that time and generally am made aware of any laws that would affect employment issues.
2.) Check with your state insurance commission. It's possible that Nevada has such a law (I've never had employees in Nevada though I have in Florida) and your employer is confusing a state law with a Federal.
3.) Check the policy. As I said above, such clauses are unusual but not unheard of. It's not impossible that your specific policy has such a provision.
Answer
I appreciate the information.
Hopefully I can do this in a way that will avoid a negative response on my employer's end.
Answer
And as much as I preach about being knowledgeable of your health insurance plan, this is one situation that sucks. I have nothing to add but condolences regarding costs and congratulations for the birth of your child.
Answer
I have nothing to add to the info given by cbg but I am just curious as to what you would have done?
>>Had we known that we were not covered we would have made other arrangements.<<