Can the insurance company still send a bill for this medical expense?

Question

Someone I know has arthritis and gets an injection every couple months. She was at a job that covered the injection but she was in the middle of changing jobs. She put her two weeks notice in on 8/8/07. They told her to consider that her last day and not to work the two weeks out. They also told her, her insurance would still cover her injection on 8/10/07. She had the injection and just today got a bill for $13,000 for the injection on that day. She also got a letter on 9/10/07 saying her insurance was up on the day she was let go but the work place said she was covered for the rest of the month. Her new job she started the next week has insurance to cover this. Why was she billed now for it? Who fault is it and what should she do to get this right. She obviously doesn't have the money to pay and shouldn't. Thanks for your help, this is so insane.

She never mentioned anything about COBRA coverage. I am pretty sure if she had the option to take coverage for this appointment she would have. This isn't something that snuck up on her. She is meeting with her cousins boss who is a lawyer to get things settled tomorrow. I could see if she got let go on the 8th, got a letter on the 9th that her insurance was gone, then had the appointment on the 10th anywa then it would be her fault. But also to get billed over 4 months later for this? Something isn't right.

I asked the same thing, if it was 13,000 or 1,300. She said it was 13,000. I don't see how it could cost that much but I am going to see her today and try and help her work things out. She is going to meet with her cousins boss, the lawyer, and see what is going to happen. It makes it seem even worse that is it 13,000. If it was 1,300 then she could pay for it.

Answer 1

Hiya:

You know when you get your paycheck....the deduction for the health coverage has already been taken out?

That means you are 'paid up' for your health insurance.

Unless her health carrier refunded her money for what she was 'paid up' for......they can't just cancel her.....and she would in essence still have coverage until the end of that pay period.

Answer 2

Well, first of all, the employer can't tell her that the insurance company "will" cover her injection on 8/10/07. Its outside the scope of what the employer is able to determine for a variety of reasons (employer doesn't know how the doctor is going to bill the claim, employer doesn't know whether she's exceeded the frequency limits for her particular injection, etc.)...only the insurance company can tell you that something "will" be covered.

Now, the employer should be able to tell you when your insurance is going to end after you leave a job of course. That's something that's pre-defined by your benefit contract...typically either your coverage ends on the last day of your employment or on the last day of the month during which you leave employment.

What your friend needs to do is pull out the policy she had in effect at the time - it should clearly state whether her coverage would terminate on the last day of the month or as of the last day she worked. (If she no longer has a copy of the policy, she should be able to get a copy from the insurance company.)

If her coverage was supposed to end on the last day of August (according to what is defined in writing in her policy), then her former employer should certainly update her termination date with the insurer. The doctor can then reprocess the claim.

If her policy states that her coverage should end on the last day she works, then she might be in trouble. Even if someone in HR verbally told her that they thought she'd be covered until the end of the month, its her word against theirs...for all she knows, she misunderstood them. And its going to be hard to prove that a verbal, undocumented discussion should override what it says in writing in her policy.

As far as why she's getting the bill now...the doctor's office probably took about 30 days to bill the insurer, who then probably took about 30 days to issue their response to the claim saying she wasn't covered. Then it probably took another 30 days for the doctor's office to then turn out a bill to her. (Billing is often done at month end.) So, its not at all unusual that she's just getting the first bill a few months later.

Answer 3

It's not the insurance sending the bill but the provider who gave the injection.

She may want to contact the benefits manager from her previous employer. She may have been offered COBRA benefits/option to continue her insurance paying out of pocket for the premium. If she refused this coverage (and usually you have to sign something saying you refuse it) the bill may be her responsibility.

The bill may or may not have been submitted to the first employer's insurance. She should have received an "explanantion of benefits" saying that it was denied if it was submitted. It would probably read something like "policy not in effect for date of service".

It is not unusual for providers to have some delay in billing especially when there is a change in insurance coverage. Insurance companies aren't swift in their responses.

Answer 4

There have been many helpful responses to this situation posted, so I won't add another. HOWEVER, I have to wonder just what type of injection this person is getting that would cost $13,000. The three common injectables for rheumatoid arthritis are Remicade, Enbrel, and Humira, NONE of which cost anywhere near that amount. Are you sure she's not talking about $1,300, and not $13,000 ?

Answer 5

If she didn't get it in writing, that she was covered until the end of the month, she's responsible for that bill.

She was billed for it, because it wasn't covered under her insurance.

Ultimately, it's HER responsibility to call the number on the back of her card, and verify that she's got coverage after her employment has been terminated. Also, she COULD have accepted COBRA for that two weeks or so she was uninsured, and THEN it would have been covered. So I guess she decided to go uninsured.

She can present the bill to her prior employer, and say, ok, you guys told me it would be covered, and it's not, so YOU pay it. BUT, if they say, No we didn't, or We meant IF You signed up for Cobra, then she'll have to sue them, and then it's her word against theirs, and she'll likely lose (go back to, she declined to take the COBRA coverage, choosing to go uninsured during that time).

Meanwhile, the provider IS going to sue her for the money, and as they did provide the service, they're going to win. So she can expect to get wages garnished.

She should have taken the Cobra coverage.

Answer 6

She would have been able to continue her coverage under COBRA anyhow-she might have to pay some premium but should act now before it's too late. You would need to check state law or w/ a local attorney for any issues w/ the company and insurance company but something's not right. I have been in the insurance field since 1991. Coverage is usually on a monthly basis-that's how the employer should be billed-not on a partial monthly basis.