H.G. asks from Ponder, TX on April 13, 2010
Insurance/HR Error Need Some Advice Please
My husband's HR department just contacted us ( almost 3 years after our twins' birth) to let us know that our insurance policy was never changed from employee + 1 to family. Therefore, they want us to pay for their mistake....an $1800 mistake. My first question is, should this be our responsibility since it wasn't our mistake? Our children have had insurance coverage since their birth, and have clearly been on my husband's policy. Can my husband be dropped from our insurance coverage or lose his job if we decide to fight this? Thanks for the help in advance.
M.R. answers from Chicago on April 13, 2010
Chances are that your insurance policy WAS changed but the rate at which your husband's company billed him wasn't changed. I say this because if your insurance policy was not changed, then every claim that your childrens' pediatrician would have filed/tried to collect upon would have been denied if you didn't have coverage.
Looks like they billed you improperly and as much as it might suck, you do have a responsibility to pay for insurance that you've been enjoying (apparently for free) for the past three years. Imagine how much the difference would be if you had to pay full price for the medical needs of your children - would you rather be paying that instead?
It's exceptionally unfortunate that the billing was never changed but since his company has been paying premiums for full coverage then you are responsible. Your best bet here would be to work with the HR department to work out a repayment plan to spread out the amount owed over several months. Furthermore, make sure that this matter is taken directly to whomever is in charge of HR at his company and let them know the financial strain that such a careless error has had on your family. Good luck!
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S.B. answers from Redding on April 13, 2010
First off, your husband should not have to worry about losing his job over fighting this. As far as losing his insurance, it depends on whether they say they will drop you for not paying up.
Do you have proof that the children were covered and their check ups and things were paid for by the policy?
If so, that's good news. It means the insurance company recognized your children as covered dependents.
Now, if they are just now realizing that the premiums were never adjusted to reflect the increase in dependents, that's a different story.
As an insurance agent, I would fight for you to only have to pay upon notice or going back one month, but not a full 3 years. If your kids had claims that were paid, you obviously weren't being deceptive or fraudulent in any way and had every reason to expect that the premium amount was correct.
I don't know about the laws in Texas, but in California, mistakes like this are not usually absorbed by the subscriber.
Now, if you didn't report the birth of the kids within 30 days and there were no claims against the insurance policy, such as you took them to well baby clinics, etc instead, there is no need for them to collect for premiums on a policy never used. That could be another argument in your favor for why you didn't know the kids weren't added.
It sounds like your HR department let something slip or the insurance carrier never caught it until now.
You'd have a very difficult time having them go back to pay a 3 year old claim they never knew about, so it seems they would have a hard time going back three years for you to pay premiums you didn't know about.
I would call the insurance carrier yourself, note the date, time and person you speak to and see what you can find out that way.
Your HR person may be wanting money back that they failed to collect and that's another matter. Could be a little bit of butt covering going on. If they weren't taking enough out of your checks to begin with, or however it's set up, that's not on you. In my opinion.
I hope you get some good responses.
2 moms found this helpful
S.R. answers from San Francisco on April 13, 2010
Was it that your twins weren't added to the policy or that they were added but his employer forgot to change the monthly cost for employee +1 to employee family? Family plans are usually more than husband/wife plans. If they didn't increase the cost and should have and have now realized it then as much as it sucks I would say you should pay it. I would also work something out with HR on a payment plan since you owe it but wasn't your mistake. Not sure if you have the $1800 or not but that is a small price for 3 yrs of coverage. Ours is a couple hundred a month for adding family. I'd be careful fighting it if it is your responsibility and their mistake just because you don't want anything negative to happen in this economy, even if it's not your fault. Good luck. Let us know what happens.
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C.H. answers from Dallas on April 13, 2010
I'm married to a lawyer but didn't ask him about this. Each state has different rules on different things. But I agree with your other respondent on this:
If your company has paid for it and that's why your kids were covered, it is understandable and fair for them to bill you for what you should have been paying them all along. I am sure that they could make payment arrangements for you to give you a comfortable repayment period.
If that's not the case, I have different recommendations.
1 mom found this helpful
T.J. answers from Seattle on April 13, 2010
Were you given information on how much the policy would increase when you added the two kids? Do you pay any of the insurance premium out of pocket? If yes to both, is there a reason you (or he) didn't realize you were paying less than you were supposed to? Other than that I agree with everyone the other mama said.
P.R. answers from New York on April 13, 2010
It depends if you have the paperwork to back this up and if you can get each side's story straight. I've had years of extensive medical claims (for infertility and high-risk pregnancies, including twins) and over time there have been mistakes with insurance claims that have had to be sorted out. Sometimes in their favor, sometimes ours. It's never easy.
Your case is unusual, because the HR dept and the insurer don't seem to agree about when coverage started. Why is your husband's company billing you and what is the $1800 for exactly?
If the company clearly made a mistake in changing the status of the policy, part of your children's claims were not covered and it's too late to file a claim, I think they shouldn't charge you if they're at fault. If it was an honest mistake, like underbilling premiums, then I think you should pay (word will get around to co-workers if you don't and that's never good).
If the policy was employee + 1 family and you are the "+1" the birth should have been covered (with you as the patient). It might have clasified as high risk, and the hospital cost could have been far greater than the $1,800 - sometimes tens of thousands.
EOBs for the entire hospital stay (both for you and the babies) will show how much was charged, how much was allowed and paid, and how much you were responsible for (deductible, copay, coinsurance and non-covered amount). Sometimes your responsability can run pretty high, especially with frequent tests done in twin pregnancy - for example $1,000 bloodwork for my pregnancy done in one occassion had $200 coinsurance. A friend's high-risk pregnancy had hospital charges of $60,000 (I'm not sure how much she paid).
That said, you need to contact your insurance company to see when coverage for the children begun, and what your deductible and coinsurance limits are. Write down dates, times and who you spoke with at the insurance company. Confirm what was spoken in writing by fax or e-mail, with copy to your HR. If you have evidence of when you notified HR/ insurance company regarding the birth, all the better
I doubt he would lose his job or coverage if you fight it, just line up your ducks in a row, "gently" gather as much paperwork and evidence both from your employer and from the insurance company, especially with all the EOBs, and try to see where the disconnect happened.
If it's for past due medical expenses - see if there were any bills sent from providers directly at the time - which would happen if there was no insurance coverage. It's possible that one of the many providers present at a twin birth wasn't in-network with your insurer. In any case, if a provider hadn't been paid by now, you would have heard from their collection department a long time ago. If it's a bill that shows up three-years after the fact, there might be a statute of limitations in your state with regards of when you can be charged.
Or as M.R. states, it could have been that your company didn't charge you for family coverage (only employee +1) and you had family coverage, in which case the $1800 is the difference in premiums for these three years (paycheck deductions before/after birth can show this). That you should pay, if not legally, then morally.