I left my job for a new one in November 2023. My health insurance from company A ended the same day I left. I got new insurance through company B, but not through my employer.
I canceled the B plan in March 2024 because it was awful. We only found out how bad the coverage was after getting a bill for one of my daughter’s visits that cost $2500 for just a routine check up with vaccines.
My husband used to get a high-priced medication. When we switched insurance, he updated the info with the mail order pharmacy, and he had a copay card for the medication. We always had no out-of-pocket cost for it.
So, we thought, with company B and the copay card, the medication was covered.
That turned out to be wrong.
The mail order pharmacy didn’t update properly and kept billing company A instead of company B. Company A kept coverage going for 5 months from December 2023 to April 2024.
Recently, we got a letter about the issue and they want us to pay back over $15,000. I guess they found this out during their year-end audit since the letter is dated January 2025.
Knowing what I know now, I am pretty sure company B won’t cover this medication.
We would have rather gone without the medication than pay back the thousands of dollars they are asking us for, which is again $15,000.
Is it legal for them to do this? They paid for it, then want us to pay them back without us knowing they were covering it?
We usually got letters when they paid for something, but I never received one for these charges…
Edited to add:
I’m female, 32, my husband is male, 27, and our daughter is 18 months old—if that matters.
We live in Illinois and have a yearly gross income of about 45,000.