Really need some guidance here. TLDR at bottom
My wife is the policy holder through her previous/current employer (same employer). She left her job on Nov 12 and accepted an offer to go back on Dec 6.
Prior to her separation, I broke my elbow which required surgery/hardware. Through this we met my deductible and out of pocket max for the year. The hardware has caused complications with mobility and ROM. The elbow joint does not do well being immobilized for long periods. The fracture is now healed and they suggested a 2nd surgery removing the hardware asap (said if I wait any longer I may experience permanent damage).
Throughout this entire process we were prepared to opt into COBRA for the remainder of the year. This made the most sense, with my out-of-pocket max being met for the year, the cost of cobra would still allow the insurance company to pay for the entire second surgery. up until yesterday, doctors offices, physical therapy and hospitals have shown my insurance to still be active. We have contacted the third-party who handles cobra enrollment a few times over the last month and each time I’ve been told they haven’t received any separation information.
The surgery was scheduled for today. Yesterday morning I got a confirmation call from the hospital telling me what time to be there today. Then, yesterday afternoon they called back and said the preauthorization has been pulled, that my insurance has become inactive. We have contacted the human resources department at the employer, and the third-party they use to handle cobra. The ball was dropped. The employee separation information was never sent over. From my understanding, they have 30 days to contact us after separation. This would be Monday the 12th. As of right now we do not have the option to opt into COBRA. This may or may not get sorted out in a timely fashion. However, the surgeon is only in town for another week and will be out for the holidays for the remainder of the year. They have put me on the schedule for next Friday, which is the last possible day I can get the surgery this year.
This is starting to sound like this is going to result in us not getting a $15,000+ surgery paid for this calendar year and potentially permanent damage to my arm. Who do you contact in these kinds of situations? Should I contact an attorney? If so what type?
TLDR: Wife’s employer didnt send employee separation to 3rd party that handles cobra. I’ve had multiple surgeries this year that have resulted in my out-of-pocket max being met. The final surgery (to prevent permanent damage) was scheduled for today. The pre-authorization was pulled yesterday due to the insurance becoming in active. However, since information wasn’t sent over we cannot opt in to COBRA at this time. I have one week to get this sorted out before the surgery isnt an option (holidays). If I am unable to get this sorted out should I contact an attorney?
submitted by /u/xxjgxx1
[link] [comments]Really need some guidance here. TLDR at bottom My wife is the policy holder through her previous/current employer (same employer). She left her job on Nov 12 and accepted an offer to go back on Dec 6. Prior to her separation, I broke my elbow which required surgery/hardware. Through this we met my deductible and out of pocket max for the year. The hardware has caused complications with mobility and ROM. The elbow joint does not do well being immobilized for long periods. The fracture is now healed and they suggested a 2nd surgery removing the hardware asap (said if I wait any longer I may experience permanent damage). Throughout this entire process we were prepared to opt into COBRA for the remainder of the year. This made the most sense, with my out-of-pocket max being met for the year, the cost of cobra would still allow the insurance company to pay for the entire second surgery. up until yesterday, doctors offices, physical therapy and hospitals have shown my insurance to still be active. We have contacted the third-party who handles cobra enrollment a few times over the last month and each time I’ve been told they haven’t received any separation information. The surgery was scheduled for today. Yesterday morning I got a confirmation call from the hospital telling me what time to be there today. Then, yesterday afternoon they called back and said the preauthorization has been pulled, that my insurance has become inactive. We have contacted the human resources department at the employer, and the third-party they use to handle cobra. The ball was dropped. The employee separation information was never sent over. From my understanding, they have 30 days to contact us after separation. This would be Monday the 12th. As of right now we do not have the option to opt into COBRA. This may or may not get sorted out in a timely fashion. However, the surgeon is only in town for another week and will be out for the holidays for the remainder of the year. They have put me on the schedule for next Friday, which is the last possible day I can get the surgery this year. This is starting to sound like this is going to result in us not getting a $15,000+ surgery paid for this calendar year and potentially permanent damage to my arm. Who do you contact in these kinds of situations? Should I contact an attorney? If so what type? TLDR: Wife’s employer didnt send employee separation to 3rd party that handles cobra. I’ve had multiple surgeries this year that have resulted in my out-of-pocket max being met. The final surgery (to prevent permanent damage) was scheduled for today. The pre-authorization was pulled yesterday due to the insurance becoming in active. However, since information wasn’t sent over we cannot opt in to COBRA at this time. I have one week to get this sorted out before the surgery isnt an option (holidays). If I am unable to get this sorted out should I contact an attorney? submitted by /u/xxjgxx1 [link] [comments]Read Morer/HealthInsurance