My mother is retired but had health insurance through her employer. The employer decided to stop offering health care insurance.

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MomLittleHelper Asked September 2016

My mother is retired but had health insurance through her employer. The employer decided to stop offering health care insurance.

retired employees had to go through the marketplace to buy new supplemental insurance.
While her old insurance was still in place, she fell and shattered her upper femur. She was operated on and in a rehab/nursing home through the transition from one insurer to the new one. The new insurer is refusing to pay for the rehab facility saying the stay began before their insurance took effect.
The old insurer said their responsibility ended on December 31, 2015.
What options do I have here to help my mother?

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score 3 · Answer 1

I had a situation like this during my first pregnancy. Got pregnant on one insurance plan but delivered under another. There was no lapse in coverage. The two companies fought over this until my daughter was a year old. I forget what the resolution was, but someone paind up. Both the NY attorney general and state insurance commission helped me out by forcing the two companies to talk. I was clearly not going away.

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score 2 · Answer 2

Very good answers, Babalou. Some insurance companies will look for a reason to deny a claim, but cover it if the client pursues it. It is like they hope the client will just accept the loss and go away. This is one situation I wouldn't want to sort through on my own.

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score 1 · Answer 3

I'm assuming there was no COBRA coverage offered or considered?

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score 4 · Answer 4

If her coverage was continuous ( if there was no lapse in coverage) the old insurer is likely liable. She should contact the state insurance commision in her state to get them to sort out the responsibilty. For starts, she neds to appeal the denials, in writing and send copies of all her correspondence to the SI and attorney general.

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score 3 · Answer 5

With the cost of rehab being pretty steep, I think I would talk to a lawyer about this one.

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My mother is retired but had health insurance through her employer. The employer decided to stop offering health care insurance.

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