Health Insurance Claims

[Prescott]

I am a 64 widow who is having trouble with my health care provider paying my bills.
I worked for my company for 23 years and then retired.
I went on cobra for 18 months and send my payments to my old company.
2 months before cobra was to end I signed up with my new insurance company.
I went into the hospital 7 months later and because I had insurance before I though they would pay my bill.
Because my company went on a new insurance carrier and didn't tell me, I didn't know I wasn't covered for 2 months.
They said I had 45 days to get new insurance.
I didn't know I wan't covered until they haven't paid my bills because they said time elasped.
I feel it wasn't my fault so I need help.

[Elphin]

Working in human resources myself, I can probably say like the others that they are denying your claim because of pre-existing conditions clause. In NY if you have continuous health coverage with no break you are covered for any and all pre-existing conditions.
But if you have a lapse in coverage for 60 days then any expenses that are considered pre-existing will only be paid at 50% for the first year of the new health insurance coverage.
After the 1st year pre-existing conditions are paid in full.Proper notification should have been made to you IN WRITING of the company's change in health carriers.
Change in carriers require new enrollment applications.
If no notification was made to you nor did you receive any enrollment application for the new company then they are at fault. Good question was raised.......did you pay the COBRA premiums for those last 2 months? If you did, I would say the employer is liable for picking up your expenses.
If you didn't, then I think you are out of luck because they can just say they terminated you from the plan for non-payment of premium in which case that's a lucky break for them.

[hokee70]

Very, very, very important question.Did you send in your payments for January and February 2005 COBRA?

[Dremidydd]

You were hospitalized 10/21/05.The critical question is why the claim for 10/21/05 is being denied when you had coverage on that date?Did you get a letter explaining the denial? I'm thinking it might have been related to a pre-existing condition exclusion rather than the lapse.

[Wattkins]

I appplied for brand new insurance Jan. 04, 2005. I had been advised I could not start untill 03/15/05. I imagined my cobra was still ineffective before end of february. 2005.I went to the clinic 10/21/05 for busy heart failure. I'd been handled for this under my previous strategy. I began to obtain characters in the physicians and clinic about expenses not being paid.In Feb 2005 among my buddies in the previous organization named me and explained they'd a brand new insurance company began January1, 2005. They forgot to place me on for that month or two I still had with cobra. They stated they'd place me on-but I stated that I'd fresh insurance therefore it was not necessary.I did not understand this could result my new insurance company spending my expenses. They stated I had not utilized over time for that new protection. It wan't my problem when I did not understand I wan't maintained for Jnaurary and March. I received a Certification of Team Heath Protection from my previous provider. Day insurance began 10/01/2001 Day finished 12/30/2004. I sent this notice to my new insurance company 05/30/06 this really is once they refused my claims, I spoke to somebody plus they stated it'd be examined but I still have not heard in the fresh insurance carrier.I wish this opens issues up.

[Brookson]

I do not realize the schedule here.You went in to the clinic 7 weeks once you registered to get a fresh insurance policy.Presumably you taken care of the brand new plan, why are not they spending your statements?And where does the outdated policy on COBRA are available in? You would not have settled on that once you were spending about the new plan anyway.How doesn't having protection for just two weeks 7 weeks previously have something related to your present hospitalization?Observe if you're able to clean up your question.

[Anrai]

I believe it is because of the preexisting problem because of the mistake centered on what she's saying. I have observed that in guidelines - they wont exclude preexisting problems as long as that you don't possess a mistake greater than XX times between policies.Did you contact your former organization officially (not about the telephone) and ask why they did not tell you the change of the insurance provider?