Results 1 to 5 of 5
  1. #1
    Join Date
    Dec 2011
    Posts
    1

    Default Retroactive Benefit Termination

    My question involves insurance law for the state of: Georgia

    My husband voluntarily terminated his employment with a company in mid-August 2011. On September 2 I utilized our health insurance for an in-office doctor's procedure and on September 18 my child was seen at their pediatrician's office for a scheduled appointment. On both days the insurance coverage was verified and approved. Both bills were paid by the insurance complany upon their receipt of the bills. Now, 4 months later they are sending requests to the doctor's offices requesting refunds of the amounts paid.

    My husband was notified in October 2011 that he had never been listed as an inactive employee by his company and when the corporate office of his employer was notified of his resignation they retroactively suspended his insurance to his original date of resignation.

    The doctor's offices are looking for us to pay the money the insurance company wants refunded. We thought we had insurance coverage and never would have attended the appointment if we had not. The bills were paid in full and it is of no fault of ours the insurance company was not notified of the inactive status.

    Are we repsonsible for the amounts owed to the doctor's offices if they choose to return the money paid for services rendered and if so do we have any right to request compensation from the employer because this was their screw-up?

  2. #2
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,236

    Default Re: Retroactive Benefit Termination

    Are we repsonsible for the amounts owed to the doctor's offices if they choose to return the money paid for services rendered Yes.

    and if so do we have any right to request compensation from the employer because this was their screw-up?
    Of course not. Why in heaven's name would you think that you still had health insurance from that employer nearly a month after your husband left the company?

  3. #3
    Join Date
    Oct 2006
    Location
    supratentorial region
    Posts
    818

    Default Re: Retroactive Benefit Termination

    Are we repsonsible for the amounts owed to the doctor's offices if they choose to return the money paid for services rendered ....
    The Doctor doesn't get to "choose" whether to refund the insurance company. When your insurance company finds it's error in payment, they automatically deduct the money from the Doctor's future payments/EOBs for services s/he provided to other patients who happen to have the same plan or coverage..

    The first thing one hears when calling for coverage verification is the insurance company's disclaimer: "Verification of coverage is not a gurantee of payment".

    The bills were paid in full and it is of no fault of ours the insurance company was not notified of the inactive status
    .

    What made you think you continued to have insurance coverage AFTER your husband's employment terminated?

  4. #4
    Join Date
    Sep 2005
    Location
    Behind a Desk
    Posts
    98,846

    Default Re: Retroactive Benefit Termination

    It sounds like you were probably eligible to continue your benefits under COBRA, so it seems reasonable to ask: If that's the case, did your husband receive timely notification of his COBRA rights? It seems possible that with the mix-up they might not have given you timely notice.

  5. #5
    Join Date
    Dec 2011
    Posts
    10

    Default Re: Retroactive Benefit Termination

    How many employees does the former employer have? That's my first question. Federal Cobra law only applies to those employers who have 20 or more total employees. That notwithstanding, most states also have a minimum continuation provision that may provide a bit of a safety net...need to know how many people work for the former employer first, though.

    1. Sponsored Links
       

Similar Threads

  1. Life Insurance: Can Creditors Take My Benefit
    By esteban in forum Insurance Law
    Replies: 9
    Last Post: 08-31-2011, 02:00 AM
  2. Unemployment Benefits: Benefit Year End Date and Continued Emergency Benefit Eligibility
    By DavidC in forum Employment and Labor
    Replies: 2
    Last Post: 01-22-2010, 07:02 AM
  3. Job Benefits: Non Medically-Related Retroactive Health Care Termination
    By mightymiff in forum Employment and Labor
    Replies: 2
    Last Post: 01-21-2010, 10:35 AM
  4. Getting Fired: Retroactive Termination in Georgia
    By GeorgiaBoy in forum Employment and Labor
    Replies: 1
    Last Post: 03-21-2009, 12:46 PM
  5. Job Benefits: Retroactive Termination of Health Benefits (COBRA Related)
    By starlight41 in forum Employment and Labor
    Replies: 2
    Last Post: 09-20-2008, 03:02 PM
 
 
Sponsored Links

Legal Help, Information and Resources