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Law Educator, Esq.
Law Educator, Esq., Attorney
Category: Employment Law
Satisfied Customers: 110501
Experience:  20+ Years of Employment Law Experience
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Below is a copy of a letter I submitted to my employer and

Customer Question

Below is a copy of a letter I submitted to my employer and to my health insurance provider as a benefit of my employment. As you can see I was terminated with a retroactive date and this has caused problems with medical claims. I need legal advice about this situation.Donna J Matthias*****
Cherry Hill, NJ 08003
Jan. 14, 2016
Highmark Blue Cross & Blue Shield of Delaware
PO Box 1991
Wilmington, DE###-##-####RE: Member ID XHP122253381001
Dear Highmark:
I am disputing unpaid claims to three medical providers for 3 medical visits in the month of August 2015. The claims are for Advantage Sleep Centers, Eye Physicians and Dr. Daniel Ragone. The reason for my dispute is simple. I was insured by Highmark through my employer, Horizon Services, and was out on disability due to a stroke. My health insurance was terminated retroactively to the date, August 1st , 2015 however I was never informed until August 24th, 2015 As proof of this I have new insurance cards that were issued to me on Aug 18th, 2015. Enclosed you will see copies of these cards. Since termination of my medical insurance was retroactive the liability for any medical costs incurred between August 1st and August 25th, falls on Highmark and Horizon Services. It would have been impossible for me to know I was not being covered and have evidence of coverage as shown by the enclosed insurance cards (copy of them.)
Advantage Sleep Associates - date of Service 8/2/2015- Amount of Service - $999.00 all for Highmark, $0.00 copay
Eye Physicians - date of Service 8/13/2015- Amount of Service - $220.00, $180.00 for Highmark, $40.00 for my copay (copay paid).
Dr. Daniel Ragone - date of Service 8/24/2015- Amount of Service - $120.00 , $80.00 for Highmark, $40.00 for my copay (copay paid).
I have enclosed a copy of the newly issued insurance cards showing my proof of insurance at the time of these visits. Please review this and please make payments to the providers and update me with a written statement of the payments. This issue will end up in litigation if the claims are not paid. I have clear evidence of insurance and proof for retroactive termination of health insurance.
Thank you for your time and attention to this matter.
Donna J Matthias
Cc: Horizon Services, Advantage Sleep Associates, Eye Physicians and Dr. Daniel RagoneThank you very much for your assistance, if you need copies of the enclosures mentioned in the letter I can send them also.
Submitted: 4 months ago.
Category: Employment Law
Expert:  Law Educator, Esq. replied 4 months 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.

An employer cannot terminate benefits without notice to the employee in advance of termination of benefits. Also, they had to offer you COBRA benefits to pay for your health insurance so you would not have a gap in insurance. Your first step is to contact both the state commissioner of labor and the US Department of Labor, since both of them investigate improper insurance benefit termination. Most times the US Department of Labor will be able to resolve the matter, especially if they failed to properly provide notice and failed to provide you COBRA coverage.

NJ statutes 34:11A-17 Notice by employer of termination, change of benefits.
2. An employer that provides a health benefits plan as defined in section 2 of P.L.1997,c.192 (C.26:2S-2)to its employees in this State shall provide, in writing, 30 days' prior notice to those employees before the health benefits plan is terminated; except that, in the case of an employer that changes a health benefits plan, the employer shall immediately notify its employees in writing of the change upon receipt by the employer of notification from the health insurer that its employees will be covered by the new plan

If the US Department of Labor and NJ Commissioner of Labor cannot resolve the issue with the employer, then you would have to sue the employer for the improper termination of benefits and also for violation of COBRA.