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Law Educator, Esq.
Law Educator, Esq., Attorney
Category: Employment Law
Satisfied Customers: 111489
Experience:  20+ Years of Employment Law Experience
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I called to obtain COBRA before a hospitalization in

Customer Question

I called to obtain COBRA before a hospitalization in January, 30 days after leaving my employer. They plan administrator did not have my information and refused to accept payment at that time. They explained what I needed to tell the hospital to get retroactive coverage. I went to the hospital and was told that my employers' insurance was still active and I was still covered. I explained it had been 30 days and the admitting clerk informed me she had called the insurance and it was still active. I had my surgery and went home. (Appendectomy). At the end of March I received my first call and first letter stating that my coverage was denied. I called the cobra benefits administrator and was told that I could not elect cobra because it was more than 60 days. I appealed and have been denied.
Submitted: 1 year ago.
Category: Employment Law
Expert:  Law Educator, Esq. replied 1 year ago.

Thank you for your question. I look forward to working with you to provide you the information you are seeking for educational purposes only.

If the employer did not provide you COBRA notice and the opportunity for coverage as required by law, the first step is you need to file a complaint with the US Department of Labor, as they oversee the COBRA program and enforcement. If the US Department of Labor cannot resolve this, which they seem to be able to do in most cases, then your next step is you have a basis to sue the employer for the violation of COBRA and you can seek coverage as well as reimbursement of any costs that should have been covered and attorney's fees as well as potentially up to triple damages if the employer is found to have done this willfully and maliciously.

So your next step is a complaint to the US Department of Labor (http://www.dol.gov/ebsa/contactEBSA/consumerassistance.html). If they cannot resolve this, then you need to engage a local employee benefits attorney to sue the employer.

Customer: replied 1 year ago.
They did provide the COBRA information. They say it was mailed the day after I contacted them. I did not apply as I was told my employer coverage was still active for the appendectomy by the hospital. I was told any follow up care related to the appendectomy was als covered. I had health insurance through my new employer 3 weeks later.
Expert:  Law Educator, Esq. replied 1 year ago.

Thank you for your reply.

You need to contact the US DOL regarding the situation, since you were told you still had coverage at the time you sought benefits. You need to let the DOL get involved and they could end up making you pay the COBRA premium for that period, but it would be cheaper than paying the medical bills. If DOL cannot resolve it, then you would need to sue since the coverage was valid and they tried to cancel it retroactive.

Customer: replied 1 year ago.
I'm not sure I understand the last sentence.
Expert:  Law Educator, Esq. replied 1 year ago.

You said the insurance was active, then after the fact, once they told you the insurance was still in effect, they went back and are trying to cancel it retroactively without notice to you. If the DOL cannot resolve the issue, then you would have to sue the insurer and employer for breach of contract telling you the insurance was active and then retroactively saying it was not active and refusing to pay the bills.

Customer: replied 1 year ago.
They told me the insurance was active at the hospital but it was incorrect. I was not made aware of this until more than 3 months later which was after my 60 days cobra enrollment period.
Expert:  Law Educator, Esq. replied 1 year ago.

Thank you for your reply.

The only legal chance you have here at making them pay is in proving the insurance company misrepresented coverage to you and argue they did so to deceive you and delay you from paying for the COBRA benefit until it was too late. That is what I was trying to tell you above.

Customer: replied 1 year ago.
Ok, got it. This is terrible. I'm a nurse for pete's sake!! I am so frustrated!
Expert:  Law Educator, Esq. replied 1 year ago.

Thank you for your reply.

You need to push this matter as I tried to point out above. Many times the DOL can get the insurance company to agree to reinstate benefits with payment of back premiums to thus allow them to pay your medical bills from the time you were supposed to be covered.