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Old 03-10-2017, 09:55 AM
 
5 posts, read 1,798 times
Reputation: 10

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I apologize in advance for the long rant, but I'm beyond frustrated with this...

I switched jobs last November, but I had a 90-day grace period with my new employer before I could enroll in their medical benefits. So, during that 3 month period, I enrolled my entire family in Cobra coverage.

I paid over $6,000 for my 3 month cobra coverage, to a 3rd party Cobra company. My problem however, is my prior employer has STILL not submitted that Cobra payment information to their insurance company, Blue Cross Blue Shield. Therefore, every doctor visit that my family needed to go to during that 3 month period, I needed to pay 100% out of pocket. With a wife going through a complicated pregnancy, I've already paid thousands extra in out of pocket medical bills, all because my prior employer won't submit the paperwork. In many cases, my wife couldn't even get through the dr office door without first paying some $400-$600 up front payment.

It's become nearly a weekly thing. I call my prior employer, ask to speak to their HR dept, to their Cobra specialist, to HR managers, to the HR manager's manager...whomever will listen. I then get a response saying they'll jump on it immediately & submit the paperwork to Blue Cross. Then...nothing. Blue Cross never receives the paperwork from them & I repeat the process the following week (it can take up to a week for Blue Cross to update their systems, so I need to wait a week between each call).

So, my question is...what can I do about this? I'm running out of options to turn to. Blue Cross Blue Shield says there's nothing they can do because they never received paperwork. The 3rd party Cobra company says there's nothing they can do because they've submitted everything they had to submit to my prior employer. And my prior employer doesn't seem to give 2 sh**s. These phone calls have been going on for about 3 months now & it's the same conversation every week. I don't know what else to do.

Does anyone know if there's a higher authority I can report my prior employer to? A gov't agency or someone responsible for these things that can maybe intervene? All I'm looking for is for my prior employer to tell Blue Cross Blue Shield that I paid for Cobra coverage. That's it. I don't think I'm asking for too much. I've tried being nice. I've tried yelling & yet every time, they say they'll get right on it, and yet....nothing happens.

Sorry for the long rant. Just frustrated.

Thanks for any advice you can provide.
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Old 03-10-2017, 10:04 AM
 
Location: Alexandria, VA
10,711 posts, read 19,040,812 times
Reputation: 14653
State Insurance Commission?
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Old 03-10-2017, 11:00 AM
 
Location: OH>IL>CO>CT
4,747 posts, read 7,491,873 times
Reputation: 6347
The US Dept of Labor is responsible for the COBRA program

contact the Employee Benefits Security Administration (EBSA) electronically at
askebsa.dol.gov
or call toll free 1-866-444-3272.

https://www.dol.gov/sites/default/fi...e-consumer.pdf
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Old 03-12-2017, 09:06 PM
 
702 posts, read 357,274 times
Reputation: 1513
You need to request a copy of your prior employer's summary plan description from the Human Resources Department and you need to determine if your coverage is a self funded ERISA plan (this means funds to pay employee claims actually comes from your employer and BXBS is just the claims administrator) OR if the coverage is a fully insured product (meaning your employer bought a policy through BXBS and BXBS actually funds all claim payments. If your former employer is self funded they call all the shots and BXBS works for your employer. If it is a fully insured product BXBS has final call regarding all claim and eligibility isdues.

If your employer is self funded I would recommend hiring an attorney that specializes in ERISA to write a very strongly worded letter to your employer, BXBS, and the COBRA administrator to get this issue resolved ASAP or you will be filing a Department of Labor Complaint and/or a lawsuit for your outstanding claims. A letter should only cost a few hundred dollars.

If your employer bought a fully insured policy and human resources failed to get your COBRA info/payments where they needed to be timely you are going to have a tough battle. The burden of proof is going to be on you and your employer will likely claim you did not turn in your paperwork and/or payments timely. In this case, I would have the attorney write a letter to all three parties and advise they need to resolve this situation ASAP or a Department of Labor Complaint, Department of Insurance Complaint and/or lawsuit will be filed.

When did you leave your job?
What date did you send in your COBRA app?
Who was the COBRA app sent to?
When did you make your COBRA premiums?
Were the checks cashed/payments accepted?
If your wife's pregnancy was complicated how much were total claims?

Good luck!

Last edited by Angie682; 03-12-2017 at 09:19 PM..
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