Husband Denied Health Insurance (plan, hospital, Humana, coverage)

[randnday]

Our situation is not only unusual, it's quite complicated to boot. The main culprit in all this is the Postal Service's Human Resources Shared Services Center, giving us wrong information for months, & even signing us up for health insurance when they shouldn't have.

We have had coverage for over 4 decades under my husband's employer. His job & that coverage ended at the end of November, 2014. He had a 60-day window under the "qualifying life event" period to obtain new insurance. I am a Postal employee, but currently disabled and on OWCP (Federal workers' comp). I knew zip about how health insurance worked with the Post Office b/c I'd never needed it, but called the Post Office HRSSC line for advice. They said, "no problem," and signed me up for the month of December with health insurance for the both of us. Then they said I'd need to enroll for 2015 online, using the "PostalEase" website. I called them numerous times, nervous that I was doing everything correctly, and each & every time I told them I was not working & was on OWCP. Still "no problem."

When it was time to enroll for 2015, I again got on the HRSSC line to have them walk me through the steps. I didn't just want to enroll, I also wanted to change insurance companies. So, I enrolled on PostalEase with the new insurance company as ordered and received a confirmation with a number. All seemed well for my husband & me to be insured for the next year at least. I also enrolled in a dental plan for just myself, as my husband didn't need dental work & we figured it would be less expensive for him to just pay out of pocket for check-ups & cleanings.

After a few weeks I became a bit nervous that I hadn't received any further notifications from the health insurance company. The dental insurance had been sending all kinds of informational emails and a card came in the mail, but nothing from the health insurance. So finally I called the company and was told we WEREN'T enrolled! "How can that be?" "We don't know. You need to call your HR # and talk with them about it." So again I called HRSSC. They told me that I had indeed been enrolled, but that somebody had come back later and cancelled the enrollment. "Why?" "I don't know." After insisting that somebody find out what was going on, somebody finally came on and told me, "You can't enroll with PostalEase when you're on OWCP. You have to go through OWCP to get insurance." Well, how nice of them to tell me after open enrollment was over with.

So, I call OWCP and they tell me, "Too bad, too late, open enrollment's over." I tried to explain that I'd been given wrong info from HRSSC and thought that should make a difference in allowing us to enroll, but the claims examiner insisted over and over that it was simply too late, tough luck.

After thinking about it for a while, I realized that, hey, we were still within the 60-day qualifying life event period, and called OWCP back. However, this time the claims examiner said, "Doesn't matter. As long as you're not working, you can't sign up for health insurance through the post office unless you were already enrolled." Wasn't that nice of her not to just tell me that in the first place? (Meet OWCP - the people whose goal is to make injured workers' lives as miserable and complicated as possible.)

However, when I again called HRSSC, trying to get answers, I was told again, "not to worry! You were already enrolled with BC/BS in December, so you can still keep your policy with that company. You didn't succeed at changing companies, so you're still enrolled with them." Well, hallelujiah for that!

Things seemed fine until May when my husband went to get a prescription filled. BC/BS had been covering our dr bills and scripts just fine until then, but at that time he was told that they had cancelled our policy on April 22. After a flurry of calls and questions, we were finally told that "it was a mistake to keep you enrolled after December after all." Apparently somebody figured out that we weren't supposed to be able to stay on the BC/BS after all, and summarily cancelled it without bothering to notify us. So... since I'm disabled and eligible for Medicare B, I began the process of getting that & we began searching for options for my husband. (The Medicare fiasco that ensued is a story of its own that was a nightmare, but I won't go into that.)

We had to get letters from my husband's prior company insurance verifying that he'd had insurance through them through Nov, 2014, and after some urgent phone calls, BC/BS also sent a letter verifying that he'd been insured with them through April 22, 2015 (even though we're now required to pay back everything they'd covered up to that date.) So, he applied immediately for insurance with Humana. After a looooong wait... he was denied! According to them, they didn't have to take the BC/BS into account, despite their verification of insurance through most of April. They knew nothing about the mess we'd gone through. They simply denied him for no good reason. Basically they said he should have applied within 60 days of losing his company's health insurance, but with BC/BS verifying insurance until April, they really had no right to say that.

So, for several months he called different insurance companies, and then the 60 days really was up, so he had to find a company who would give him insurance for just a few months at an exorbitant fee.

What I want to know is, is there anything we can do to make Humana give him insurance retroactively? Or are we too late to appeal? It's like they don't care what the rules are, they make up their own as they please. I know this is all a big mess, and we were led astray originally by the PO HRSSC, but cryminy! I guess at least now it's almost open season again, so he can apply. But he just had a scare and spent a week in the hospital. We haven't gotten the bill yet, but I have a feeling we're going to have to refinance our home to pay for it. It just doesn't seem right that they can get away with this kind of shenanigans.

[Qwerty]

Were you paying premiums all these months? You need to call the person back that told you all was ok, they probably have the conversation recorded. If you were paying premiums, they either need to refund those premiums or issue a certificate of insurance showing he was covered and you were within the timeframe to apply under a life event (the April rescind of the policy). With the refund check and/or the certificate of insurance you should be able to go to Humana and show that this is what has been going on. If the hospital bill is significant, it might be worth getting an attorney involved. Did you document the dates you talked to HR and to whom you spoke? That would be helpful as well. I would make an appointment with the director of HR if you can and see what they will do for you.

[randnday]

Thank you, Qwerty! No, about the premiums. We called numerous times to ask how to pay them! It was confusing to say the least, but eventually somebody told me the premiums would be deducted from my workers' comp benefits. They never were. By March we were becoming alarmed about it, mainly b/c we were afraid our insurance would be cancelled. Well, it was alright, but not for the reason we expected.

However, they did issue a certificate declaring that we were insured until April 22. That's what I don't understand. We sent that to Humana, but they refused to honor it. It took some doing to get BC/BS to issue that to us, but we finally got ahold of a nice person who did it for us. What they did was fill out a form we were given by Social Security, as well as writing a letter declaring that we were insured by them until April. Didn't matter to Humana. They insisted on saying he had to apply within 60 days of losing his work insurance back in November.

Actually, after we realized we were getting the run-around from the PO HRSSC, we began recording the phone calls ourselves. We can always look at our cell phone bills to see all the dates we called them as well, clear back to October, 2014. I probably made 20 calls last year to make sure I was doing things correctly. I never thought about seeing if HRSSC has the calls recorded, though. Good idea, and thank you!

As for the attorney, yes, I believe you're right on that. He barely had enrolled in this insurance he found that cost an arm and a leg, and is for short-term only, effective on October 1, so we dodged that bullet at least. However, I haven't reviewed his policy & we could still owe thousands. I suppose we'd owe several thousand regardless, with the deductible on other insurance.

Anyway, thank you for your response, Qwerty. I've been feeling so alone and lost in all this, and it really helps to have someone with good ideas who cares.

ps Most of all I'm grateful my husband's alive. I focus on that most of all. The cardiologist said he was on the brink of sudden death for 3 days.