(From Washington State)
After being married at the end of December 2006, I worked with my HR/accounting person to enroll my new wife in the company's health care insurance program. I filled out the form he told me to, checked "health", "dental", and "vision", and he faxed it in for me. I said, "Is that it?" He said, "Yep! All take care of!" So, I thought everything was fine, and my wife was covered. Well, at the end of February, my wife had an emergency appendectomy, then some follow-up visits, and then a complete physical in March. About the middle of March, I started to receive bills from the hospitals and clinics (totally about $11k) saying that coverage had been denied since this person was not covered. I immediately talked to the HR person, who contacted our insurance broker, and was then informed that "only one of the two forms were filled out" - we have two "providers": one for dental (I'll call them Company A), and the other for health and vision (I'll call them Company B). I hadn't been told to fill out the one for health and vision. One important point here is that one single company is responsible for "administering" enrollment and changes for both "plans". We sent an official appeal to Company B, saying that the intent for enrolling in both dental and health was clear, and we heard nothing back from the Administration Company that anything was wrong with our submitted form, so they should accept my wife's enrollment retroactive to January when the original form was submitted. The Appeals Committee for Company B rejected our appeal - twice, without any substantive explanation.
The other option I was hoping to purse was Employee Benefits Administration Liability, since obviously the HR person gave me the wrong instructions on how to enroll my wife. However, now my company is saying they "don't have this type of insurance".
Any advice on where I stand legally on this? Who could I talk to about something like this?