Parent's healthcare refuses to pay for claim during dates of coverage, My healthcare refuses to pay for claim due to their own reasons.

hevymetlmystic

New member
Let's call my insurance Q and my mom's insurance B. So, I was under my mom's healthcare for most of the year last year until I turned of age. My mom quit her job earlier that year. I thought my healthcare was going to terminate on my birthday so I tried talking to my employer to get enrolled. They first told me to consider COBRA, I've had problems with them in the past where it seems like they didn't want to pay, so I called up B-insurance after my birthday trying to figure out if I could join their individual healthcare plan if my job refuses to allow me to enroll. They ended up telling me that I had 30 extra days of coverage because of my mom's job. So, what I did was a follow-up appointment for my thyroid-heart issues within those extra 30 days. I called on the 30th day (My birthday is on the 31st of the previous month, and I called the 30th of the next month to enroll in Q-insurance from my job). Ex: Birthday is Aug 31, was told I was covered until Sept 30th. On B-insurance's website it says: medical - Coverage End 09/30/2017, dental Coverage End 08/31/2017, on top of all of that.

Fast forward, I get a bill in the mail that says that B-insurance won't cover the bill. After a bit of back and forth, I was told today by B-insurance that "even though you were covered, your policy ended on the 31st, your birthday". I called up my job's benefit's center (Q-insurance) and they told me they won't retroactively pay for my claim because I had enrolled past the 31 days of a life-qualifying event, and now they're saying because I said on the 30th I lost health coverage on the say, Sept 30th and my coverage for dental and vision ended on my birthday, they started my coverage for the next day for both, say, Oct 1st and therefore they won't cover my healthcare claim.

It seems like Q-insurance refuses to cover this claim under the original basis that I waited too long to claim coverage (which, if that was the case, why would they have allowed me to enroll in dental/vision on Sept 30th since that coverage ended on my birthday), Q-insurance won't retroactively take the claim. B-insurance says that my policy didn't end until the 30th of the next month, but I don't have coverage because of my birthday. They said my mother needs to call in and rectify the issue, potentially with her original employer.

In-person HRs don't exist at my job, so I have nobody to ask in-person, but I can contact that same hotline.

I'm in healthcare limbo where everyone is avoiding my healthcare claim. Is there anything I can do, or any advice as to what to do so I won't face any major potential financial repercussions, or am I SOL? This doesn't seem right.
 
@hevymetlmystic Your tale is a bit confusing.

I thought my healthcare was going to terminate on my birthday

which one is "my insurance" at this point - B, or Q?

I was under my mom's healthcare for most of the year last year until I turned of age. My mom quit her job earlier that year....

....so I called up B-insurance after my birthday trying to figure out if I could join their individual healthcare plan if my job refuses to allow me to enroll. They ended up telling me that I had 30 extra days of coverage because of my mom's job.

why would B extend you any coverage now, given that neither your mom nor you has been covered for, presumably, many months?

And you've described Q as "your" insurance, when in fact you haven't actually had "Q insurance" - Q is what your employer offers, but you werern't enrolled believing you were covered by mom's insurance, which you probably weren't, for several months now. Do you KNOW if mom somehow continued her coverage from B after she quit? If she didn't, you weren't covered either, & would not satisfy any conventional qualifying standards for enrolling in your employer's plan.

Employers will typically ask you to document your eligibilty to enroll "off cycle" (outside their customary enrollment periods). They don't typically just act on your telling them you are eligible. What documents or messages have you gotten from either of these health plans about this situation? If you can de-identify any you've gotten (remove your name/address/company name/anything that would readily enable someone to know you are you) & post, that might help clear up the confusion about what's going on here.
 
@ryanc111 In the case of "my insurance", I meant I thought B-insurance was going to terminate on my birthday.

My mom was still paying for coverage on my behalf after no longer being at the job (she actually retired). My mom most likely has documentation from B-insurance, though I don't know what that documentation says regarding date, though I do know that my claims were processed for any time leading up to my birthday.

I was ultimately told by B-insurance that my coverage ended 30 days after my birthday, and that's also what it indicated online. My dental and vision terminated on my birthday, also indicated online. B-insurance didn't extend me coverage up until present-day (sounds like what you're thinking had also happened), only that my medical was extended for an extra 30 days past my birthday, while dental and vision were not. This is the online screenshot, sorry for the silly edits: https://drive.google.com/file/d/1sPJYhpx7QFzAkFKzlN5lOtnanXDTCHHR/view?usp=sharing

I had gone to the doctor some time between Sept 1 - Sept 30, and my birthday is Aug 31.

I enrolled in Q-insurance on the Sept 30 for health and vision, they did allow me to enroll in vision on that day.

My employer actually did not ask for any kind of documentation to prove this life event, it was verbal via their hotline. Unrelated, but yes, I did call prior to my birthday to understand what needed to be done. I'll see if I can upload documents here.

Edit: https://drive.google.com/file/d/1XeL9DMzsOhMsWkTPrfluLGygKaLIFrSo/view?usp=sharing
(where the 30th would be, like Sept 30) and, this next image isn't relevant but it shows you what's on the other side of this document.
https://drive.google.com/file/d/1XeL9DMzsOhMsWkTPrfluLGygKaLIFrSo/view?usp=sharing

That's all I have from my employer.
 

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