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Insurance Fraud or Something Like It?
We were paying for health insurance (blue cross & blue shield CareFirst PPO) through my husband’s job every two weeks for over a year until he quit on August 26th. But every time he or my son went to the doctor, they were coming back as ineligible. Upon calling the insurance company, I found out that no one on our policy had been eligible since March of 2008! This is also the time that his company went through an HR problem where they had no HR dept. at all for quite a few months. The lady at the insurance company said that someone from his job had gone in and adjusted our policy on September 3rd so that it shows no lapse in coverage. There should BE no policy; my husband quit on August 26th. The lady also said the policy is still active and covering our family. If someone went in and adjusted the policy, why didn’t they put the termination in?? We would like to get back the money paid into this since March, which is about $1200.00. The lady from the insurance company said that since the adjustment was made, all the denied claims will be paid. We would rather have the money and pay the bills off a little at a time, since the reason he quit is that we got evicted because the company cut everyone’s hours so badly and we have NO money. Is there a scenario where we can still get the money and was this legal of them in the first place?
The company that he worked for is the one that screwed up by not paying for the policies. They probably realized it when they went back to put in his information for COBRA. The insurance company is trying to do the right thing by covering your expenses. You may want to see exactly how much you would be paying for those doctor visits if you did have to pay them yourself before you start demanding the premiums back.
It’s probably not possible to get the money back. And not smart. Hopefully, you will get back on your feet quickly and get health insurance again. Most companies have a pre-existing condition policy and if you have not had insurance coverage for over 60 days, anything that is wrong with you will not be covered. It would be soooo much better for you to have a more recent cancellation date.