I went to the doctor several times in September and used my health insurance. A couple days ago, I got a notice from my employer that my health insurance was cancelled as of 8/31/2024 because I’m not estimated to work the minimum hours to qualify for it anymore (I’m a part-time employee and I went on leave this fall).
I looked and several of the claims from the September doctor visits have already processed with the insurance paying most and my amount listed. What will happen to these claims? I am going to either go on my husband’s insurance or use Cobra but I haven’t done either yet. Will the claims automatically be re-billed with the new insurance?
Edited to add: I work for a public school district so we have employment contracts that run 9/1-8/31 for each year which is why I believe they used this date.
Any claims processed through the now terminated coverage, will be clawed back. Get on your husband’s or a marketplace plan asap. Like tomorrow, so you don’t miss the QLE event to do that. I’m not positive if it’s 30 or 60 days from loss of coverage. Then contact all providers and request them to submit claims to your new carrier. ETA… you seem to also have the ability to go on Cobra. If you have met out of pocket, or close to it, it may be a better option than going on husband’s or marketplace and starting ded and oop all over again.
@Briar
Thank you! We are going to figure out which insurance to get today because I know it’s right at the 30 days. Kind of surprised they just notified me now, a couple days before the QLE ends. Do I need to notify the providers or will they automatically claw back the claims and then see the new coverage?
@Ashton
You will need to notify the providers and insurance about the correct coverage for any dates that were paid with your old carrier. As I mentioned, if you had met ded/oop through your coverage, that’s probably the best bet, but it’s quite expensive. If adding you as a spouse isn’t out of reach, that’s also a viable option. Marketplace plans tend to have very narrow networks.
@Briar
Thank you. We did not meet the OOP but we did meet the deductible for the year. COBRA is crazy expensive for mine, so I think we might go for a $0 deductible plan on my spouse’s insurance since it’s not much more per month.
@Ashton
You can do one month of COBRA which would cover your care received in September. You’ll want to determine whether a month of COBRA premiums will be cheaper than whatever your doctor(s) will end up billing you directly once this is clawed back by your former insurer.
A healthcare.gov policy won’t backdate coverage to 8/31, nor will your spouse’s employer-sponsored plan. When your old insurer claws back, it’ll be as if you never had insurance for September, and those claims would then be your responsibility as a self-pay patient. Only COBRA will offer retro-coverage to 8/31 if activated and paid for.
@Marlow
Double check with the employer, because my self-funded plan backdated one month for my husband, through the QLE not the date we notified them, we just back paid the premium as well.
AstroAdept said: @Marlow
Double check with the employer, because my self-funded plan backdated one month for my husband, through the QLE not the date we notified them, we just back paid the premium as well.
Thank you, so I’d contact my spouse’s employer to see if they will backdate one month for the 30-day QLE?
One more question… so basically if it doesn’t backdate, are we SOL for coverage for September unless we go with Cobra? Seems like it should backdate so long as you sign up within the special enrollment window?
No, they will not be rebilled. Your former insurance company will eventually take back those payments from the affected providers who will then bill you.
Asher said:
No, they will not be rebilled. Your former insurance company will eventually take back those payments from the affected providers who will then bill you.
SO they bill me but if I have new retroactive insurance at that point I would have them re-submit to the new insurance?
@Ashton
Right. They won’t know what insurance you have. All they will know is that your former insurance clawed back their payment. They will rebill if you call and give them updated info.
Asher said: @Ashton
Right. They won’t know what insurance you have. All they will know is that your former insurance clawed back their payment. They will rebill if you call and give them updated info.