Can Health Insurance Drop You For No Reason?
My sister was recently dropped from her healthcare insurance. When she attempted to call her insurance company, the phone menu directed calls for people insured through the affordable healthcare act to one extension (which never connected through) and everyone else to a different extension. After several failed attempts to reach someone though the assigned extension, she attempted through the other extension, which she was put through immediately. She was informed that she had been dropped for lack of payment, which she had not been late. They (the insurance company) then informed her there had been a mistake and she had actually been cancelled several months earlier, thus refunded her $1100.00. She questioned their actions and they were unable to give her an explanation. This feels really fishy on the part of the insurance company. Is this a new technique to eliminate coverage for those enrolled via the affordable care act? Are other people also experiencing being dropped for “late payment”?
Health insurance can only drop you during your policy year for non-payment, fraud, or misrepresentation. You can appeal any insurer decision. As for your specific issue, we haven't heard of it. Hopefully others will comment below and post similar experience. People should note what state are in and what insurer they are using.
UPDATE: Over time we have realized there is a big problem with plan drops on private individual and family plans. We are working on a 12-month continuous enrollment solution. If you have had your plan dropped for a billing mistake join us in the fight by sharing your story. Together we can ensure change.
Absolutely this is happening.My friend found out he didn’t have insurance when I went to pick up his medications. He has never been late on payment, his payment was automatically taken out from the bank. My friend is in the final stages of COPD and congestive heart failure and has to have his inhalers. No insurance. He is on disability but hasn’t been on it long enough to get Medicare. This is very shocking news when you find out you can’t get your meds,can’t afford to go to dr.. There should be something we can do. There has not been ONE person to tell us WHY.The response is must be a mistake on computer and it will take us a month to get it straightened out. A lot of paper work. So I guess if you die in the mean time that’s just less paper work they have to deal with. We live in North Carolina and his coverage was the Platinum Plan
That’s horrible! The mistake I made, according to BCBS, was sign up with the healthcare marketplace. They will feed every excuse in the book, they are never held accountable but be a minute late on payments or encounter a clerical error and they drop you like a hot potato. At some point, they need to give back instead of take everything.
I had almost an identical experience TWICE in the same year with United Healthcare (through the marketplace). It has been a nightmare, and almost a year after my policy with United ended, I am STILL fighting with them. I enrolled in auto withdrawal (in other words, united was responsible for deducting premium payments each month), and due to a “system error” I was kicked out of the system. Nobody from the company ever notified me. We received a few letters saying that coverage was ending, but every time I called to inquire I was told “it was a mistake” and “don’t worry.” Don’t you think the company would CALL those affected to notify them of something so important? Ike the person above noted, most of my phone calls were dropped or routed to offshore representatives who read from a script and repeatedly gave misinformation. The phone number for United Healthcare listed on its website has been DISCONNECTED for months with no new number given, essentially making it impossible for consumers to get any resolution. I’m sure that is a purposeful move by United.
I had almost an identical experience TWICE in the same year with United Healthcare (through the marketplace). It has been a nightmare, and almost a year after my policy with United ended, I am STILL fighting with them. I enrolled in auto withdrawal (in other words, united was responsible for deducting premium payments each month), and due to a “system error” I was kicked out of the system. Nobody from the company notified me. We received a few letters saying that coverage was ending, but every time I called to inquire I was told “it was a mistake” and “don’t worry.” I even recorded phone calls from supervisors confirming that it was all being taken care of, but the bills I continue to receive say otherwise. As the person above noted, most of my initial phone calls were dropped or routed to offshore representatives who read from a script and repeatedly gave misinformation. The phone number for United Healthcare listed on its website has been DISCONNECTED for months with no new number given, essentially making it impossible for consumers to get any resolution. I’m sure that is a purposeful move by United.
Same as me!
IHC – independent health solutions- misrepresented the policy telling me that RX would be $10 which was a lie. Did not tell me that the RX plan was not part of the insurance plan. Didn’t inform me that it didn’t meet obamacare criteria so I learned I would have to pay tax on it also.
I emailed stating my frustration and disappointment, they replied by canceling my policy. So when I went to the doctor I had insurance but now they are voiding that so I am screwed for my annual visit and blood work. How is this legal let alone ethical?
I work for CVS, with insurance through Aetna. I have worked there three years. Last year I only worked part time from July to November. I went full time again in December. I now work 36-38 hours a week. I have been covered since the first week of March. Now CVS is telling me they are dropping my insurance as of June 1st based on my part time hours from last year. Is this legal ??? What if anything can I do about it ? Who do I appeal to ? I live and work in Pennsylvania.
They can use “look-back periods” which are pretty flexible for employers. If they are wiggling around the rules to avoid providing coverage, then you may have grounds to say something. It’s sort of a complex grey area that is much easier to deal with when the employer simply does the right thing on their own. Since you now work full-time, they will have to re-instatate you at some point, but again, we are talking a complex situation. Maybe just take it up with them, mention lookback periods, and try to get a straight answer.
The same exact thing happened to me. Blue shield retroactively cancelled my insurance and gave me back the money I had paid after jan. 1st. They sent me 3 different letters way after the fact that cancelled me on 3 different dates. They refused to let me fight it. I hit a brick wall. Now I don’t know what to do I have chronic pain and all my medications went up in price since this cate act took effect. I can’t even pay full price. I have to wait til Nov to apply again. I rage inducing.
My health insurance dropped me with similar “non-payment”circumstances – they sent me back my payments of over $1000. I do not get subsidized at all. Yesterday, the girl at our dentist office also had a nearly identical experience. Non-payment is when someone fails to pay deliberately – not through clerical errors. How is it in the interest of big insurance (BCBS was mine) to drop a premium full paying member? BTW if you are in need of medication during a blackout, try contacting the pharmaceutical company directly – they may offer plans to provide the Rx.
after seven months of coverage and frequent communications with BCBS they now say we dont have a policy. They paid our med bills for seven months and now we dont have a policy. ARe they obligated to let you know aboutt a loss of coverage?
I just found out that my son was dropped from BCBS of Iowa. He was diagnosed with Inconclusive Ulcerative Colitis/Crohns disease in 2013 and has been very ill with it. He recently started infusions and they are very expensive to do. His father and I have been divorced since 2002 and his dad and I had an agreement that he would put insurance on my son since he lived with him, and I would have insurance on our daughter since she lived with me. (Verbal agreement)Just recently BCBS of Iowa cancelled all his claims as far back as 2014 to present and saying he owes all this money to the hospitals and clinics because my insurance should be primary not secondary insurance for my son. Which it is not. BCBS of Iowa should be primary because that is my ex-husbands insurance and mine should be secondary. It has been this way since we were divorced. BCBS of Iowa just does not want to pay for any more of my sons medications that he needs because they can cost up to $6000.00 or month for each infusion he has to have. I believe they used the excuse that we did not get the primary/secondary insurance in writing and that is why they cancelled my son’s insurance, so they would no longer have to pay for his expensive medications and numerous doctor visits and tests. Iam seriously thinking about suing the insurance company.
I had almost an identical experience TWICE in the same year with United Healthcare (through the marketplace). It has been a nightmare, and almost a year after my policy with United ended, I am STILL fighting with them. I enrolled in auto withdrawal (in other words, united was responsible for deducting premium payments each month), and due to a “system error” I was kicked out of the system. Nobody from the company notified me. We received a letter
saying that coverage was ending, but every time I called to inquire I was told “it was a mistake” and “don’t worry.” I even recorded phone calls from supervisors confirming that it was all being taken care of, but the bills I continue to receive say otherwise. As the person above noted, most of my initial phone calls were dropped or routed to offshore representatives who read from a script and repeatedly gave misinformation. The phone number for United Healthcare listed on its website has been DISCONNECTED for months with no new number given, essentially making it impossible for consumers to get any resolution. Surely this is a purposeful move by United and other insurers to avoid covering consumers they were able to “drop” before the ACA was in effect.
We are facing a similar issue. We live in Pennsylvania and have Medical Assistance. We have been submitting our income according to the income guidelines, but found out all of us were dropped for failure to submit income.
We did everything we were suppose to do, and they still dropped us…I am a pregnant mom with 2 of my 3 children diagnosed with special needs.
They were unsympathetic and saying it was obviously my fault, and when I asked them if they recieved the scans and faxes they requested I couldn’t get a straight answer.
I am devastated that my children currently have no medical coverage and my 2 Children are not getting the mental help they need.
If my insurance company reimburses me $1300 on a $4000 dental procedure then, sends me a letter saying it was a mistake and wants the full $1300 back, can they drop me if I refuse to give it back. My policy is set up so I pay in advance and the insurance reimburses me.
I live in Texas and Humana dropped me for no reason. I asked why and the women said it was because of financial reason on their part. Is this discrimination?
YES this exact thing happened to my mother! My mom got on a marketplace insurance plan. Paid all of her premiums. Towards the end of the month she called the insurance company to go ahead and pay for the next months insurance only to find out that her insurance had been cancelled. Not because of non-payment, because all payments were made early and in full, not because of fraud or misrepresentation. Blue Cross Blue Shield and Marketplace kept giving her the run around. Marketplace told her it was BCBS’s fault and BCBS kept saying it was Marketplace’s fault. All my mom cared about was getting the problem fixed. She had applied and paid and was not covered by insurance. My mother is very sick and needs medical care. She needed to have surgery a year ago and has spent this past year in pain because of Obamacare. Marketplace told my mother they couldn’t fix the issue, but that they would allow her to enroll in another plan. This would be January-when all the plans went through the roof. They would not give her back the plan she enrolled in and paid for before they “mistakenly” dropped her. We spend HOURS on hold trying to get ahold of anyone. And every time we would get a hold of anyone they were extremely rude. Even the manager yelled at us and hung up on her when we asked for help. My mother is still in serious pain and the insurance that anyone was able to put her on, no one in our state accepts it, which is why she has yet to have her surgery. We are all praying she can make it until January when her new insurance is suppose to start, but then this is exactly where we were last year. My mother can’t wait much longer, much less another year. This insurance act was put in place to help people, and the people who are needing help aren’t getting any.
This just happened to me! I went to my local pharmacy to pick up a prescription refill and the pharm tech said he couldn’t find my insurance account info and it doesn’t look like I’m covered. So I called the insurance company and they told me that I had been dropped as of December 31, 2016 (this was January 5th when I called) because they are no longer servicing my area! I said when we’re you planning to inform me?! The rep said you should receive a letter within 10-12 business days. I thought this is nonsense!!! What huge freaking racket these insurance companies are running!!!
Total racket. How irresponsible. I will be writing about it when we are doing playing triage over the GOP repeal and delay plan, but i’m pretty sure insurers are using uncertainty to loophole people out of plans pending upcoming changes.
My orthopedic surgeon told me that he does not take etna no more,because of lack of payment.I have AVN avascular necrosis,bone disease,the only way i found out was i had a appt then they told me.All these democrats r worring about millions will die if obama care is repealed,what about the people gettig dropped like a bad habit now.I bet they do not have obama care,they are crooks and millionaire hacks.they want your vote and tell you to go screw yourself.Trump care is gotta be better than this,no wonder no one voted democrat.I can barely walk and in constant pain from hell,they have no clue about real american people and thats why hillary did not win,thank the lord.Yours trully One pist off america.
I called into my insurance today. I noticed my premium has not come out of my bank account and wanted to see what was up. Three years in the same account. Three years it carried over no matter if the premium changed. This year I was silently dropped. The insurance company (coventry health) representative told me no cancelation or premium change letter had been sent out and that I needed to shop for a new plan. I recently had some medical work done to my heart. I feel I was dropped due to that.
My insurance empire blue cross and blue shield of NY, through NYCTA, who my husband worked for 30 years, dropped me as of, 2016 and never informed me. Needless to say I never was ill or sick, and in serval visits to dr for physical , then emergency surgery in June 2016, and $6,000.00 in unpaid bills, which they approved when my hospital and doctors verified my insurance, I finally called ins co because i was getting calls from collection agencies, I do have ssi, and was told then, that as long as I have ins, I don’t need medicare b, however, being retired, it doesn’t apply, as I went back to read my record, but, why, didn’t they tell me, I don’t know that, the way it’s worded, is, if u are working and have ins,yes, my husband was working at a different company after retirement, but they didn’t say that in generic memo. I need help. Thx Maria
I live in Arkansas and the same thing is happening to me. I have been dealing with this since Oct. I do not know what to do.
I just went to fill a prescription and pharmacy told me I needed my new card which I had gotten the day before so I went home and got it and brought it back they looked at new card and told me I didn’t have prescription coverage on my new card. I went home and called insurance company and they told me my insurance was cancelled two months earlier which came as a huge shock to me I have paid my bill I am on cobra and paying 520 a month. The strange thing is I have gotten prescriptions filled after they said I was dropped and been to doctor no problem. My question is can they drop me for no reason and not tell me at anytime they were dropping me I am very very frustrated and angry
I am having the exact same problem with bcbs. They dropped my families insurance twice, for an error they made in their computer system that was never changed. Same on going phone calls, and excuses from the company. I have been with out health insurance for 8 months while I am still fighting my appeal with the company.
I was never mailed my renewal and in October, 2016 I had to call Medical Mutual to find out if I would ever receive my options for plan year 2017. After 3 weeks and 2 phone calls I was provided a verbal update about my plan. They provided 1 plan option within a medical network plan where none of our doctors participated. The problem with this is that I have a dependent that has chronic health issues, that includes breast cancer, and this was the insurers process of effectively cancelling us. We paid an average of $1,100/month for a $12,000 deductible policy where our total out of pocket including premiums amounted to well over $23,000/year for the previous 3 years. We were lucky to be able to pay our bills as our savings were depleted over this time. These problems exist all over our society. I want to know is it legal for the health insurance company to note send you renewal options? It appears to me that this was a way of dropping me and my family from coverage without proper notice.
Dropped for same reason!!!!!!Mad!!!
Same thing happened to me with Independence Blue Cross last year. Someone should file a class action lawsuit
My son and his 7 month pregnant wife were dropped yesterday from their health plan which they purchased through the exchange. He was 20 days late with his payment. When he realized it he called immediately. They accepted his father’s payment, which was the same amount of time behind in the payment. He was told that he and his wife now make too much money to qualify for a subsidy and that there insurance had to be dropped due to there combined income. They are now left uninsured. They had not received any correspondence alerting them that they were going to be dropped. My son tried to pay the late amount and the next month amount to bring the account back in force. He was told that they could not accept his money and that there was nothing he could do.
They shouldn’t have been dropped due to income changes, they should have only been dropped from tax credits. Whole thing seems fishy, I would appeal it.
I have been enrolled in a plan through Florida blue through the marketplace and always paid every month. I was dropped for no reason at all in march 2018 with no notice. I went to pick up medicine at the pharmacy and they told me. I called Florida blue and they had no logical reason. They told me I didn’t make payments, so I now have to get my bank statements to prove. Every time I call it’s a different story. I am trying to appeal through the marketplace. I made all my payments! I know they are supposed to give 30 days notice which they didn’t do. Also they took my money and still dropped me anyway. They may have computer issues, but it seems to be affecting many people who are regularly paying, causing panic and anxiety to customers.
your sister is not the only one being done that the marketplace did that to me and ambetter
they try to say for late payment but when I told them that was a lie that I could provide that I have not been late they started blaming each other.best thing I can tell your sister is to record all of her phone calls ,have her start asking about her taxes credits my self am turning both place in to Jefferson city and to the Irs because my my Inc and that what they did put my payments back into my account so now I have all the Dr bills coming in from January Feb March.I think if everyone start turning them something might get done