I’m feeling really anxious and scared . My wife was initially insured through her company (Company A), but I switched her to my state of Delaware insurance to save money after getting a job there. I thought her employer covered less than 50% of the insurance cost, making her eligible for my plan. However, I’ve just learned her employer actually covers about 75%.
My concern is, are we in trouble? We just had a baby in May under my insurance. Could the claims now be retroactively denied, leaving us with the bill? Are there any legal consequences for this mistake?
I’ve been worrying all night and can’t reach anyone at my employer or the state benefits office. Any advice?
I really apologise for your feelings. Retroactive denial refers to the process by which an insurance company reverses a paid claim, requiring you to make payment. This may occur if they discover that the coverage was invalid at the time. Check Delaware’s regulations as many states have restrictions on when this can be done. Especially if it was done on purpose, giving false information on insurance applications might result in denied claims, cancelled policies, or legal issues. Your error may receive a more tolerant response because it appears to be honest. If you have any concerns regarding legal matters, you should speak with your insurance company and provide an honest explanation. You can also get in touch with your employer’s benefits office for particular information about your coverage.
The main concern is whether your wife was eligible for your Delaware insurance plan. If her employer’s coverage exceeded 50%, she may not have qualified for your plan, which could lead to issues with claims, including potential retroactive denials.
Potential Consequences
Retroactive Denial of Claims: The insurance company might reject claims filed after the date when your wife should have been covered by her employer’s plan.
Financial Responsibility: If claims are denied, you could be responsible for paying out-of-pocket medical expenses.
Legal Issues: Intentional misrepresentation of information to the insurance company might lead to legal consequences.
Immediate Steps
Contact Your Employer’s HR Department: Quickly clarify the exact percentage of coverage provided by your wife’s employer.
Contact the State Benefits Office: Seek advice on eligibility requirements and potential repercussions.
Review Your Insurance Policies: Carefully examine the terms and conditions of both insurance plans, focusing on eligibility and coverage.
Consult with an Attorney: If the situation is complicated or if significant financial implications are anticipated, consider speaking with an attorney specializing in health insurance law.
Potential Solutions
Appeal the Denial: If claims are denied, you can file an appeal.
COBRA Coverage: If eligible, you might be able to enroll your wife in COBRA coverage from her previous employer.
Gap Coverage: Look into temporary health insurance options to cover any gaps in coverage.
Gather all relevant information and consult with professionals to understand your options and protect your family’s financial well-being.
. My wife was initially insured through her company (Company A), but I switched her to my state of Delaware insurance to save money after getting a job there. I thought her employer covered less than 50% of the insurance cost, making her eligible for my plan. However, I’ve just learned her employer actually covers about 75%.
and can’t reach anyone at my employer or the state benefits office. Any advice? 