Health Care/ACA question about losing coverage

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Topic Author
zanian
Posts: 28
Joined: Thu Jan 30, 2014 5:21 pm

Health Care/ACA question about losing coverage

Post by zanian »

I was under the impression that if you lose your health coverage (a qualifying event) you can get new coverage effective the next month. My dependents lost coverage at the end of September through my employer's group plan. We applied for coverage last month directly through Kaiser not through the exchanges. They incorrectly are starting coverage Nov 1. We immediately called them to change the coverage to start Oct 1, which they said would take a week or 2.

Lo and behold, Oct 1, my son screws up his arm. My wife goes to Urgent Care and we are not in their system. In calling Kaiser and speaking with many different people, and being on hold for ages, they state our coverage begins Nov 1. We finally are entered back in the system on the third try on the caveat that I might have to pay this all out of pocket.

I did get one supervisor to agree with me on the start date but I am worried by the bureaucracy and what the rules really are. Does it make a difference if you buy through the exchanges or directly?

Could Kaiser make us be uninsured for a month? or does the law protect us?

thanks for your help in advance!

cheers
HoosierJim
Posts: 987
Joined: Wed Mar 24, 2010 7:11 pm

Re: Health Care/ACA question about losing coverage

Post by HoosierJim »

zanian wrote:... lost coverage at the end of September through my employer's group plan.

Could Kaiser make us be uninsured for a month? or does the law protect us?
You have 60 days to elect Cobra coverage so you can be assured you are covered during this period even if a catastrophic event occurred. The question then becomes the difference between Urgent Care and the cobra cost. One way would be to wait until the coverage actually starts - just in case another "event" occurs, then decide on the Cobra election.
US Dept of Labor wrote:Q8: How long do I have to elect COBRA coverage?
If you become entitled to elect COBRA coverage, you must be given an election period of at least 60 days (starting on the later of the date you are furnished the election notice or the date you would lose coverage) to choose whether or not to elect continuation coverage.
BruDude
Posts: 4203
Joined: Wed Dec 29, 2010 11:28 pm
Location: Las Vegas

Re: Health Care/ACA question about losing coverage

Post by BruDude »

zanian wrote:I was under the impression that if you lose your health coverage (a qualifying event) you can get new coverage effective the next month. My dependents lost coverage at the end of September through my employer's group plan. We applied for coverage last month directly through Kaiser not through the exchanges. They incorrectly are starting coverage Nov 1. We immediately called them to change the coverage to start Oct 1, which they said would take a week or 2.

Lo and behold, Oct 1, my son screws up his arm. My wife goes to Urgent Care and we are not in their system. In calling Kaiser and speaking with many different people, and being on hold for ages, they state our coverage begins Nov 1. We finally are entered back in the system on the third try on the caveat that I might have to pay this all out of pocket.

I did get one supervisor to agree with me on the start date but I am worried by the bureaucracy and what the rules really are. Does it make a difference if you buy through the exchanges or directly?

Could Kaiser make us be uninsured for a month? or does the law protect us?

thanks for your help in advance!

cheers
Law says policy effective first of month after termination assuming you applied before October 1. I've been dealing with this problem for months on SEP applications and it can take a long time to get fixed. Had one of these take over two months to be fixed for a policy bought through the DC state-based exchange.
SoCalGal
Posts: 22
Joined: Fri Mar 14, 2014 10:35 am

Re: Health Care/ACA question about losing coverage

Post by SoCalGal »

Seriously...rely on your COBRA coverage for this.
BruDude
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Joined: Wed Dec 29, 2010 11:28 pm
Location: Las Vegas

Re: Health Care/ACA question about losing coverage

Post by BruDude »

No reason to rely on COBRA if you applied before 10/1, they will have to honor the 10/1 effective date (assuming policy was applied for in September and the existing policy ended in September too). Talk to a supervisor at Kaiser, tell them you have a pending claim and that this needs to be addressed immediately.
Topic Author
zanian
Posts: 28
Joined: Thu Jan 30, 2014 5:21 pm

Re: Health Care/ACA question about losing coverage

Post by zanian »

Thanks for all the replies. I guess Cobra is a last resort but it is very expensive. Yes I have spoken to numerous supervisors at Kaiser. Only until yesterday did we start to get worried because numerous non-supervisors claimed we had to wait till November to be covered. The hoops we had to go through just to get an appointment has been ridiculous. They are treating us like criminals. One supervisor agreed with us and stated that the law is on our side. Hopefully whoever reviews it agrees too.

We applied in September for October coverage and my dependents lost coverage effective Oct 1.


cheers
BruDude
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Joined: Wed Dec 29, 2010 11:28 pm
Location: Las Vegas

Re: Health Care/ACA question about losing coverage

Post by BruDude »

Here's a document written by Kaiser confirming first of the month after loss of coverage. See bottom of page 3:

http://healthreform.kaiserpermanente.or ... DA_LCK.pdf
linguini
Posts: 262
Joined: Tue Oct 16, 2012 2:49 pm

Re: Health Care/ACA question about losing coverage

Post by linguini »

What state do you live in? If Kaiser does not pay a claim which they are legally required to settle, you can seek external review of the denied claim through your state's department of insurance. Do you have documentation demonstrating that you applied for coverage beginning on October 1?
soccerdad12
Posts: 378
Joined: Thu Jan 19, 2012 7:52 am

Re: Health Care/ACA question about losing coverage

Post by soccerdad12 »

did he lose coverage on 1 oct or on 30 sep? That 1 oct date might be where the sticking point is. 1st of month after losing coverage on 1 oct is 1 nov. 1st of month after losing coverage on 30 sep is 1 oct.
Topic Author
zanian
Posts: 28
Joined: Thu Jan 30, 2014 5:21 pm

Re: Health Care/ACA question about losing coverage

Post by zanian »

I am in California and I misspoke, the coverage ended Sept 30th.
Topic Author
zanian
Posts: 28
Joined: Thu Jan 30, 2014 5:21 pm

Re: Health Care/ACA question about losing coverage

Post by zanian »

and yes I have proof I applied for coverage in the middle of September.
furwut
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Joined: Tue Jun 05, 2012 8:54 pm

Re: Health Care/ACA question about losing coverage

Post by furwut »

Sounds like a bureaucratic mix up. Stay on top if it and make sure you get it resolved in your favor BEFORE the COBRA 60 window expires.

But to answer your original question - yes loss of coverage is a qualifying event that entitles (requires?) you to purchase individual insurance outside of the normal enrollment window.
Topic Author
zanian
Posts: 28
Joined: Thu Jan 30, 2014 5:21 pm

Re: Health Care/ACA question about losing coverage

Post by zanian »

So Kaiser just called asking us if we want to cancel our appointment with an Orthopedist since our coverage starts November 1st. I cannot believe what a**holes they are being! I think if this continues much longer I will contact the CA insurance commissioner.

This is making me hate Kaiser.
bungalow10
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Joined: Sat Apr 09, 2011 6:28 am
Location: Chicago North Shore

Re: Health Care/ACA question about losing coverage

Post by bungalow10 »

zanian wrote: I think if this continues much longer I will contact the CA insurance commissioner.
Contact the insurance commissioner today. You might be surprised at how quickly Kaiser figures out how to start your coverage October 1.
An elephant for a dime is only a good deal if you need an elephant and have a dime.
davebarnes
Posts: 542
Joined: Wed Jan 02, 2008 6:06 pm
Location: Berkeley, Denver, Colorado USA

Enrollment process is a mess

Post by davebarnes »

We went thru something similar with Kaiser.
Their entire enrollment system is overwhelmed.
It took some time to straighten it out.
KP has been great for us since then.
A nerd living in Denver
Topic Author
zanian
Posts: 28
Joined: Thu Jan 30, 2014 5:21 pm

Re: Health Care/ACA question about losing coverage

Post by zanian »

Otherwise we are pretty happy with Kaiser. After being PPO for so long it was nice to end the endless bills and paperwork associated with doctors, facilities and insurance companies fighting over payment with you caught in the middle.
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interplanetjanet
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Location: the wilds of central California

Re: Health Care/ACA question about losing coverage

Post by interplanetjanet »

HoosierJim wrote:You have 60 days to elect Cobra coverage so you can be assured you are covered during this period even if a catastrophic event occurred.
It's worth mentioning that not all employers are required to offer Cobra coverage.
furwut
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Joined: Tue Jun 05, 2012 8:54 pm

Re: Enrollment process is a mess

Post by furwut »

davebarnes wrote:We went thru something similar with Kaiser.
Their entire enrollment system is overwhelmed.
It took some time to straighten it out.
KP has been great for us since then.
They're not the only ones. I bought a 2 month policy from Aetna last year canceling it when I enrolled via the exchange on Jan 1. Yet Aetna continued to send me billing statements for 6 months though every month I called them and reconfirmed the cancellation was 12/31.

I worked in IT in the insurance industry. Their billing systems are a nightmare of old, convoluted code.
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dm200
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Location: Washington DC area

Re: Health Care/ACA question about losing coverage

Post by dm200 »

While our (my wife and I) opinion and experience with Kaiser over the years (we have gone back and forth several times because of employer insurance changes) has always been extremely good from the medical/health aspects, we (especially my wife) have had many enrollment, billing and coverage screw-ups - some that have taken months of calling, etc. to clear up. We are in the Washington DC area.

Since you have confirmation that you applied in September, and were within the window to be covered October 1 - just keep calling and sending that evidence to any and all Kaiser folks/departments that you speak with.
linguini
Posts: 262
Joined: Tue Oct 16, 2012 2:49 pm

Re: Health Care/ACA question about losing coverage

Post by linguini »

bungalow10 wrote:
zanian wrote: I think if this continues much longer I will contact the CA insurance commissioner.
Contact the insurance commissioner today. You might be surprised at how quickly Kaiser figures out how to start your coverage October 1.
I agree with this. The insurance commissioner is there to take care of this sort of issue. Kaiser is slowrolling you, so take it to a higher authority asap instead of delaying.
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