by chobee1kenobi » Wed Mar 21, 2012 07:37 pm
Hi,
My husband quit his job on December 29th 2011 and we elected COBRA through Conexis because I have pre-existing conditions (Multiple Sclerosis, and a pituitary tumor) and it would be six months until we could get insurance through his new job. Conexis put our active date in as December 29th 2012. We were able to get Conexis to fix the mistake right away, but haven't been as lucky with UHC. We have called them at least thirty times by now and they keep telling us that it will be fixed within a time frame and nothing happens. We have paid well ahead of schedule, and we are paying almost $600.00 a month. So if this still hasn't been fixed by June 1st and my new insurance company puts a 1 year pre-existing condition exclusion on me can UHC be held responsible for that year? Would I be able to sue for the six months of coverage I didn't receive or doctors bills that they did not cover? I know I'm jumping the gun a bit, but my medications are about $3500.00 a month so I am terrified of losing coverage for a year.
Any help would be greatly appreciated.
My husband quit his job on December 29th 2011 and we elected COBRA through Conexis because I have pre-existing conditions (Multiple Sclerosis, and a pituitary tumor) and it would be six months until we could get insurance through his new job. Conexis put our active date in as December 29th 2012. We were able to get Conexis to fix the mistake right away, but haven't been as lucky with UHC. We have called them at least thirty times by now and they keep telling us that it will be fixed within a time frame and nothing happens. We have paid well ahead of schedule, and we are paying almost $600.00 a month. So if this still hasn't been fixed by June 1st and my new insurance company puts a 1 year pre-existing condition exclusion on me can UHC be held responsible for that year? Would I be able to sue for the six months of coverage I didn't receive or doctors bills that they did not cover? I know I'm jumping the gun a bit, but my medications are about $3500.00 a month so I am terrified of losing coverage for a year.
Any help would be greatly appreciated.
Posted: Thu Mar 29, 2012 02:35 pm Post Subject:
Conexis is a Third Party Administrator (TPA) working on behalf of the employer's benefit plan. You should not have anything to do with UnitedHealthcare at all. Your only communication needs to be with the TPA. You can file a complaint with the US Dept of Labor, Employee Benefits Security Administration (EBSA) to get the matter resolved more quickly if the TPA is not doing its job. You could also complain to your husband's former employer because he is paying the TPA to handle such matters.
So if this still hasn't been fixed by June 1st and my new insurance company puts a 1 year pre-existing condition exclusion on me can UHC be held responsible for that year?
A couple of things here. I think you meant to say July 1. That's when your 6 months have ended. But the Health Insurance Portability and Accountability Act (HIPPA) prevents the new group plan from imposing any preexisting condition exclusions on persons with sufficient prior "creditable coverage" -- the TPA must supply you with the certificate of creditable coverage at the time of termination from the plan (whether or not COBRA continuation is elected, and another one when COBRA continuation ends) -- you should already have that document in hand and should have turned a copy over to your husband's new employer by now. If you never received the Certificate, as required by federal law (ERISA), just add that to your complaint to the DOL ESBA. They love to investigate this stuff.
Find everything imaginable here: http://www.dol.gov/ebsa/contactEBSA/consumerassistance.html
Additionally, the PPACA (as it currently stands) may not have "grandfathered" the new employer's health plan under the former "rules". If that is true, then you cannot be denied coverage under the new group plan on the basis of a preexisting condition anyway.
Start complaining to the former employer, the TPA, and DOL EBSA -- forget United Healthcare.
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