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N Cal Atty
N Cal Atty, Lawyer
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City Medical Benefits Renewal Non-notification Query: For

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City Medical Benefits Renewal Non-notification Query:

For the past three years I have been receiving disability-based medical benefits from my city. When I renewed for the second time they asked for renewed medical documentation on the disability and I eventually had to send it twice because they claimed to have no record of the first sending.

They asked again this year and I sent them the records with a receipt thing so that I now have an email record of it being received by them. HOWEVER... I have gotten no confirmation of any kind (it's been almost two months) from them that it was received and processed and that I have been approved. Their phone number of course is useless: they simply never answer the phone (seriously!) I believe that two years ago I eventually broke through that by dialing random near-clones of the number and eventually hit a supervisor who investigated and straightened out my case problem. I am considering doing that again, EXCEPT that I am a bit concerned: my disability is at least slightly questionable (I am fairly ambulatory and can think/write) and it would be devastating to me to have the insurance removed as I have less than $10k total income.

My question is this: If by some chance I have NOT had a renewal properly processed, DESPITE my submission of what they asked and a record of that submission, would they have any responsibility for my coverage due to their lack of notifying me that the coverage was discontinued? If indeed they're still responsible in such a case I'd rather not take the chance of upsetting the applecart by pushing them for absolute confirmation (and taking the chance that in that process it might be confirmed that I am NOT renewed!)

Is there indeed a benefit in leaving the question in limbo in hopes that even if I'm not officially renewed that they would bear some responsibility for not having informed me (which action of informing would have at least given me a chance to seek private coverage instead)? I turn 62 in about 9 months and will be getting SS at that point and probably Medicare etc so this is not a long-term worry... but I'm just scared I might have an accident meanwhile and end up losing my home etc in the meantime.
You would be better off knowing one way or the other, and getting a prescription refilled is apparently what your Doctor ordered anyway, and it is a simple way to probe the situation.

You asked:
If by some chance I have NOT had a renewal properly processed, DESPITE my submission of what they asked and a record of that submission, would they have any responsibility for my coverage due to their lack of notifying me that the coverage was discontinued?
The answer to that is MAYBE but it would be harder to deal with this after you need covered treatment than it is now.

You asked:
Is there indeed a benefit in leaving the question in limbo in hopes that even if I'm not officially renewed that they would bear some responsibility for not having informed me.
No, there is no benefit to leaving this in limbo.

It they cover the prescription you can probably safely assume that all is well. If they do not, you can get a free consultation from some of the bad faith insurance lawyers listed by location here.

I hope this information is helpful.
N Cal Atty and 2 other Legal Specialists are ready to help you
Thank you for accepting my answer.
Customer: replied 5 years ago.

It was a good answer. Not one that makes me very happy given my overall financial situation (Heh, I'm living on a bit over $6,000 a year at this point. Seriously!) but better an honest answer than a feel-good answer. And you're right: I can probably find out the status simply by inquiring at the pharmacy without even raising a flag and then decide where to go from that point! Many thanks!

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