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COBRA Bite
April 7, 2010
Late Sending/ Lost COBRA Documents
I was liad off for 2 months on 12/30/2009 from my engineering job. My daughter is a full time college student on my major mecdical insurance policy and was taken ill with intestinal problems that required doctors visits and medical imaging as well as perscriptions. Wage Work lost my information and could not locate the documents as of February 07, 2010. I called three times since January 15th and Wage Works Site 120 customer service representatives stated that my former employer had not sent them the paperwork although the human resources department stated otherwise. Wage Work finally sent the forms regular mail and they arrived on February 12th, 2010 over 30 days after the date they are legally supposed to be delivered to the customer claimant. I had to call Wage Work to get the estimated rate and I sent the ARRA application, COBRA application form and check to Wage Works via regular mail. Unfortunatley, I did not send the complted forms and payment check via registered mailnad instead sent them on 02/15/2010 by regualr mail. I recieved the bills for medical imaging, doctors and perscriptions with claim denied from the hospital billing departments on 03/29/2010. When I called Wage Works about the COBRA insurance extension their claims representatives stated they never recieved any paper work or bills and that since it is over 60 days since 01/01/2010 they can not allow me to resend the completed forms along with a new check for the COBRA amount. Site 120 customer service representatives were contacted when the bills with insurance coverage denied in late March and they informed me since over 60 days had past I was no longer eligible for COBRA insurance coverage. They have refused to let me speak with their supervisors and reluctantly admitted that there was an appeals process. They grudgingly provided the details for the filing of a formal appeal and repeatedly stated that it would do me no good as more than 60 days had transpired and that all future medical bills would be denied. Wage Work's claim representatives blame this on the US Mail service and my failure to send them the forms registered mail although they sent them to me 2 weeks late via regular mail. Wage Works past tardiness and administrative/customer service ineptitude makes this questionable as to whether the forms were actually lost in the mail. I sent the documentation immediately on 02/15/2010. I think their past lateness in processing my claimant data (43 days to delivery) leading to Wage Works late send via regular mail of the forms as well as Wage Works apparent lack of an internet claims processing site tells you alot about their organization and its antiquated methodology. After two failures to have a supervisor return my calls as promised by the customer service representatives, I am skeptical that the written appeals process will be successfully resolved without legal representation.
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lfrye1
May 26, 2009
Reimbursement for Services "Not" Rendered
I unfortunately lost my job in September of 2008. I am regularly being treated for a previous job related back injury and high blood pressure. Therefore, the very minute I realized I would not be covered for health insurance; I elected Cobra coverage through Wage Works to cover me for a month while I sought out sources for more affordable coverage. Being a single female, and not having the amount of cash available to pay for my first month's premium, I took the money out of savings and elected coverage the first week of December which amounted to $603.04 (I was covered by my previous employee until November 27th, 2008), Wage Works received my check and election on December 15th. Their policy is that once payment is received and processed, your carrier (Empire Blue Cross) is notified. However, during the following weeks, I would go to doctor's appointments and pick up prescriptions to discover that I was not covered at all. Since services were already rendered, I paid out of pocket. This was very taxing on me as my check ups cost me $150 per visit (2) and prescriptions ran me over $100.00. Mind you, I am paying out of pocket from funds I received from an unemployment check! Finally, I called Wage Works after the New Year holiday and demanded to know what was going on. I was informed by the representative that they were behind in notifying my carrier due to the holiday and the amount of layoffs that were occurring. Therefore, I should call my carrier to verify that Wage Works had notified them and that perhaps it was an oversight on the part of my carrier. I couldn’t figure out why it was necessary for me to do the legwork, but I did so in earnest to make sure that I was being covered. When my carrier informed me that they had not been notified, I called Wage Works and cancelled my coverage with them. Additionally, I demanded a full refund for services that were "not" rendered. After an apology from the Customer Services Representative, I was handed over to another representative to file a complaint.
After two weeks of waiting to hear back from them, I called again. I was told that the complaint was listed, but I would not be able to receive a refund as it was not COBRA's policy to provide them. I was outdone! The representative allowed me to file another complaint, and after waiting for another four weeks, I received a check from them for the amount of $36.00. I immediately called them and implied about the check. They informed me that this was what was left me from the time I was not covered until the day I elected to cancel my coverage. This mere check was not going to appease me. I requested to speak to a supervisor. Once again, I was told that it was not the policy of COBRA to return a full refund. And, if I wanted to submit the bills for the "out of pocket" services that were rendered to me, I should notify my previous carrier, (mind you, not them). Needless to say, I was furious!!! I proceeded to ask the supervisor what does this "so- called" COBRA policy state regarding non- reimbursement. She just reiterated by saying, "It's their policy". I then asked for written documentation detailing this, but of course, she would not provide any.
My only recourse is to file a complaint with the board. I also intend to go to the media with this. I'm quite sure that I am not the only recently unemployed individual that is being duped by the scams and schemes of COBRA. It’s sad that you have of come out of pocket to pay for the excessive fees they charge. But, it’s a travesty that many of us do not have a choice, and that America is not doing something about the deviousness of the healthcare monopoly.
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