Can I Get Reinstated After Non-Payment of Premiums?
If someones coverage lapsed due to non-payment of premiums – how do they reinstate coverage and how long do they have to do this.
Non-payment is the only way, aside fraud, to get your health plan dropped. Generally you have no less than 31 days to make a payment while your plan still pays claims.
You then have a 60 day window (Marketplace plans only) in which you can make good on your payments, but your insurer can deny claims. This is the general rule, but your insurer will help provide clarification. So generally the answer is call them immediately and offer payment.
If you feel you have been dropped unfairly you have lots of appeal rights that you can set in motion immediately as well.
If you don't have any pressing medical needs, and do get dropped from your plan, you don't qualify for special enrollment. Non-payment is about the only thing that doesn't trigger special enrollment. However, there are lots of life events that do so brush up on those if you find yourself in that position.
If you are upset because your plan got cancelled, or just want to help us make a difference, check out: Health Insurance Cancellation Reform for Non-Payment.
See Did BCBS Cancel Your Plan Mid Year? Share Your Story and Let Them Know it is Not OK to Leave Hardworking Americans Without Coverage for more information.
Need my medical insurance reinstated due to non payment
In a situation where you have let your coverage lapse you may or may not have a resolution depending upon how long it has been. You should call your insurer and healthcare.gov immediately. The sooner you act the more of a chance you have to still be within the window where your coverage can be reinstated. If you feel that your insurer or HealthCare.Gov was in the wrong and your insurance was cancelled you have appeal rights. https://obamacarefacts.com/appeal-health-insurance-denial/
Insurance didn’t notify for what they didn’t pay last year
You can always check with your insurer to see what services will be covered. If something should have been covered, but wasn’t or wasn’t at the right amount you can appeal.
My partner had her insurance cancelled for nonpayment late last year. She did not pay, but she has medical reasons for non-payment, ie her disease affects her memory. We appealed through Florida Blue Cross (pushed to them by HC Marketplace) and were denied. Are any of the external review processes valid for this case? We started trying to appeal back in December and only recently received denial.
She would be more than happy to pay missed premiums. The company had approved some labwork during grace period and then denied payment once grace period was over. Those bills would be quite large. Labwork wasnt emergency and we would not have done the work if we knew we would have to pay out of pocket.
I’ve looked into the HC Marketplace appeal form and HHS appeal form, thanks to your site, but would love to know if those are worthwhile for our situation before submitting and waiting around for an answer.
We have been going back and forth with Marketplace people and insurance people, would love to get a straight answer, thank you in advance!
Thanks for the kind words.
It’s 100% work appealing the insurer (external and internal, as needed), wouldn’t hurt to appeal the marketplace too (to get it on record), even though it seems like an insurer issue.
Get more info here: https://www.healthcare.gov/appeal-insurance-company-decision/appeals/
I have been off work for about 6 months due to a work related injury. Although I receive workers compensation, I could not continue to pay my portion of health insurance premium through my employer. I am told by HR that in order for my health insurance to be reinstated I need to return back to work and work a minimum of 130 hours before I can have my insurance reinstated. I have returned to work with restrictions and work approx. 25 hours a week. Is there a quicker way to have my health insurance reinstated.
If you are not being offered COBRA or employer coverage consider special enrollment in the health insurance marketplace.
We received an email yesterday from the insurance company terminating our coverage due to non payment.
We have purchased our health insurance through the market place and my husband went in our newly established account back in December and made a payment and setup the account for reaccuring payments.
When I called the insurance company yesterday they had said that they see the January payment and that our coverage was through January 31st.
We have not received any mail/email notifying us with a bill or a warning. However, they said that there were 6 letters sent! We hadn’t received any.
My husband has just started dialysis in February and also went through a costly kidney transplant evaluation program. We have NO reason not to pay the bills have we received them.
The claims he has in feb alone are over $100k so I’m a firm believer that they just wanted to get rid of us since we are really expensive to cover. I am at a loss and not sure what to do! My husbands life depends on the dialysis and the market place agent I spoke with today had mentioned that if the insurance company refuses to reinstate the account and marks it terminated for non payment they won’t be able to offer us another insurance.
My problem is two parts:
1. What do we do going forward if they refuse to reinstate us
2. What happens to the claims from the months of February and March (till now)
Thank you so much….
We are also dealings with Florida blue just like R Wood’s partner from the comment above (January 26). I would like to ask R Wood did they get bills? Or was is a similar situation like ours where they didn’t?
Was kicked off of my healthcare plan for non-payment due to an incorrect billing address originating with New York State of Health, even though I’m more than willing and able to pay my current and past due premiums.
Never received any bills and was never contacted about overdue premiums despite having provided alternative contact means.
Was cancelled after my first month of coverage, which I paid for to New York State of Health.
Have spent over a month trying to be reinstated and no one within the system can agree on how to reinstate me or with whom the responsibility lies.
Can’t imagine how many others are dealing with the same issue. Seems unbelievable that a system error could leave you without healthcare for an entire year (til the next open enrollment). God forbid something catastrophic happens and you are forced to spend the rest of your life trying to pay for it.
This system is vastly in need of improvement. Wish I could reach someone who was willing to listen and try to help make a change but everyone I talk to seems to either pass the buck or try to put the blame on me.
I’m in exactly the same situation. eventhough i have correct address and phone numbers, the insurance company didnt even call me or mail me about the missing or due payments. now, it has been cancelled. the insurance company has sent cancellation mail to my address correctly. but, why they didnt send me the notice beforehand on the due payments 🙁
please guide me as well to come out of this worst situation. so far, i have been calling the insurance and telling that i could pay all the dues rightaway and continue my plan. any help is much appreciated!
My insurance dropped me without notice due to non-payment (the card they had on file expired ). They accepted my doctor’s and pharmacy claims until I was outside the window to pay the late bills. They claim they sent me letters, but I did not receive them. They did not email or call even though they have my email address and phone number. At the time I immediately appealed to have my insurance reinstated (I was ready willing and able to pay all owed immediately) but my exchange denied this request because I didn’t meet any of the several “life event” categories.
I had to get temporary insurance until the next open enrollment, however it was IMPOSSIBLE to purchase a qualifying minimum essential coverage plan.
No one at my local exchange or the federal program can tell me what exemption I qualify for, if any. If there was no insurance available meeting MEC requirements at any price, then this would be an affordability issue, right?
I am in the exact same situation. My insurance was cancelled after I was told I have till the 10th to pay. The 10th was a Sunday and it was cancelled on Saturday the 9th. I have been calling persistently but I find it crazy I have not gotten any answers on being reinstated and am being penalized for something I am trying to make right.
If you get canceled get right on the phone with the insurer (not the marketplace) and start there. State that your intent was to pay and notate any attempts or prior calls to the insurer. Do not wait, the sooner you take reasonable action the better. You have legal rights, but also the insurer has the right as a private business to do the right thing by you and get you reinstated. In ways, this is a better first step than the marketplace, as the insurer is who is providing you the policy.
Lost health care due to non payment, but husband is sick. We need it but we dont have any options. Tried cobra, dont qualify. It’s a shame how these companies treat you when you are going through financial hardship.
Indeed, that is why Medicaid expansion was so important, but it is also why compulsory catastrophic coverage at the very least should remain a real option on the table. For my money I’m not sure I care whether it is ObamaCare 2.0 or single payer, I do however care that people are suffering physically and financially under red tape that translates directly to more profits for insurers.
my situation is not answered. i had my health insurance with MVP and i was paying monthly with an automatic withdrawal from my Discover Card. my card got compromised in Jan. and a new card was sent to me. i have been out of the country for 3 months and was unaware that my card was no longer paying the premium. when i went to pharmacy to refill a prescription i found out that i was no longer covered????? i called insurance company (MVP) and they said they could not reinstate me because i was delinquent 30 days…….it is the Law??? don’t believe this. i am a huge Obamacare care supporter, but this is crazy.
Well to be fair this was policy before the ACA, the ACA actually extended the time you have to make good on payment. This is explained in the above answer.
It seems like you missed all deadlines, yet your insurer can still reinstate you, because they are a private company and can do as they wish in this case (if i’m not mistaken, we study the law, but aren’t any type of legal experts). You can appeal the insurer directly to this effect. https://www.healthcare.gov/appeal-insurance-company-decision/appeals/
You can also call the marketplace and get direction from them. Seems like you have some reasonable cause to take issue, even if it is ultimately on your shoulder’s according to the specifics of the rules.
In general, this sort of thing is always best done ASAP. Even waiting 24 hours is a bad idea when it comes to time-sensitive insurance stuff.
After nonpayment my insurance was canceled, I was told I needed to sign up for new ins in the marketplace website or at the insurance of my choice site. I did this late January, and after so many calls and applications I got insurance again, they informed me my coverage would start 3/1. NOW i’m being told that I was reinstated and because of the healthcare markeplace regulations they have to reinstate me for the beginning of the year, which means I am now being charged for 2 months of coverage I DIDN’T have. I do not want to pay an extra month of coverage when I had to pay out of pocket to ger medications because I was under the impression that I was not reinstated. HOW DO I STOP THEM FROM CHARGING ME AN ADITIONAL MONTH of premiums? If I don’t pay i will loose my coverage, and if i reapply they will reinstate me again and the problem will never be solved!!!
I let my health insurance lapse and honestly I did not realize with everything going on with my mother in laws help. Today I received a refund check and a cancellation date of 02/01/2016. It is with blue cross blue shield. Is there any way they might reinstate me? And if they don’t, what are my options
mother in laws health not help
I was a Nursing student at a university (since graduated) They, the University made it mandatory for we students to get 80/20 coverage with less than a 1000 dollar deductible. These plans were not cheap. The School offered a plan that could be paid through your tuition by your student loan money. (they would just include it as part of your tuition) I believe it was a little over 1200.00 ever semester (4mo. , we were a tri-semester school) So After my graduation, in Feb. of 2016. I though I was still covered until June because they sent me no notice that it would be or was being cancelled. It was a great plan, although costly but was going to pay to keep it. Well, here we are in May, I just went for a check up and was told by my PCP’s office that I owe then hundreds of dollars due to the fact that my insurance company states that I have not been covered for the last 2-3 months. They sent me no notice, did not ask me if I wanted to continue the coverage or even ask if there was another plan that I might be interested in. NOTHING. I would have gladly paid the monthly premiums to continue the plan. Is that legal? doesn’t COBRA state that they have to give me an option for continuation of benefits?
I understand the law, however I don’t agree with the law. If someone collects money from you over a period of 21 years then because of hardship is not able to pay insurance for a period of time. I believe there should be something in place that allows that person to at least receive a cash value from their policy. Even if that individual has borrowed 2,000 off the cash value of the policy. For instance if over the years I have paid in $36,000 toward a $50,000 life insurance policy then for lack of payment my insurance lapsed, I believe it is criminal for there to be a law that justifies the insurance company not being obligated to give that person at least 1/2 of the premium paid minus the money borrowed on the policy. The insurance company is still making a lot of money off that $36,000 premium paid because the money has been invested down through the years.
Very well said.
I am unable to pay my premium due to bills taking money out when they weren’t suppose to and was told my plan will be cancelled in 3 days no ifs ands or buts. I gave birth in March and then was diagnosed with hypothyroid so it’s very important for us to have insurance. Is there anything I can do to get insurance for me and my baby at this point?
It depends on the timeframe and your exact situation, you can always appeal, but it helps if you made good faith attempts to pay for your coverage. As a parent you may also have options via CHIP.
My policy was canceled for non payment. However 2 months worth of premium was accepted, and the funds have not yet been reimbursed.
I travel often for work, so I set up automatic payment for my account. I was unaware of an error with my automatic payment until I received an delinquency notice and a request to pay the two months worth of premium (months March – April). In the notice it indicated that my policy would be canceled if the payment was not received by 4/29/2016. I paid the premium immediately by check, and the funds were withdrawn from my account on (5/4/2106). I took this to mean that my policy was not canceled. I come to find out a month later that I am no longer a member, and have not been a member for the last three months (policy canceled as of February 2016). I was not notified of my policy cancelation. The payment i made for the months of April and May still have not been reimbursed. If an insurance company accepts payment, should they then provide services? If their plan was to cancel my plan, I should have been noticed immediately with my check enclosed.
This is really a question for the insurer. You always have the right to appeal, but the insurer may be able to correct this due to your good will if you contact them and explain this all calmly ASAP. Otherwise you can do a more official appeal.
You aren’t in the wrong by any normal person’s judgement of right and wrong, but you are in a techincal grey area.
If you are from WA state or another state that switched billing from the state to the insurer this year then you have extra wind at your back to work this out with them without an official appeal.
Best of luck.
I’ll just say, every day you wait gives your effort less and less “good faith” as someone who makes an honest mistake would be expected to quickly try to remedy their mistake.
The exact thing happened to me, even the same months. My insurer kept sending me invoices and accepted my online payments for 2 more months. I only realized that I did not have coverage any longer because of a bill from my doctor. It stinks when people try to make it right, try to remain covered, but errors happen. I make online payments and my April payment didn’t go though. I ended up being 35 days late and was told all I could do was wait until November enrollment. Hope that your situation gets resolved.
Is that 31 plus 60?
From memory I think it is 31 for the first market and 60 total for the second. I’d have to go back and check specifics.
I am well within the 60 day window, but Horizon Blue Cross Blue Shield of New Jersey said I canNOT pay and reinstate – they don’t do that absent exceptional circumstances. They then transferred me to the marketplace help and the person there repeated that i cannot reinstate – that there is no 60 day window for a missed payment- that my family must remain uninsured, and pay a tax penalty to boot. THIS IS THE SYSTEM THAT IS SUPPOSED TO SAVE AMERICA??!
My husband and I were cancelled at the end of April for non payment and only learned of this in the middle of July. We have been TRYING TO get caught up but it seems like what our premium was supposed to be never was what they were actually charging and now we have NO coverage and I have high blood pressure, ibs AND tracheal stenosi with no way to see a doctor or get my prescriptions!
My husband and I have been paying our premiums on time every month and went in for a Dr. appt (I am 20 weeks pregnant) to find out our plan has cancelled! This is the second year we have had problems with the Marketplace! How long does it take to be reinstated? Last time this happened, nothing got resolved and we wound up having to get a short term plan not through the Marketplace. I am furious and it was all on their end that our plan was cancelled for no reason!
Is this a joke. My girlfriend had been double billed through her online bill pay through the Marketplace and corrected it through cancelling the transaction. she accidentally cancelled both transactions by mistake and was kicked out of the Marketplace. She offered to pay and pay months ahead as its not that she can’t afford to pay the bills. By having a back issue, having an MRI done her bills are accumulating. Other serious health issues need to be addressed but she is being forced to drain her savings. This a a great woman who volunteers through-out the community and is a CASA ( that doesn’t get paid) . Such a giving honest woman that would give the skin off her back for someone in need. If she decides to wait for coverage in 4 months it could be to late as serious warning signs are there. It’s sad the government can punish an honest person and make her become depressed and worrisome everyday. Anyone have any ideas?
This answer is perfect
It has been around a month since I have been trying to get my sick husband back on Obama care I have sent in all the documents. And also it was put through as a emergency and as today 9/14/16 he does not have insurance I call every day we have to go in our savings to get his meds he has missed doctor appointments.but I will be taking him to the doctor any way. Because waiting for the program he would be deceased
I was dropped from my plan last spring for nonpayment due to clerical errors on my part. I have no intention of appealing because it was my fault but my question is can I still re-enroll during the open enrollment period in the same or a new plan?
My parenets missed paying last few months, the insurance company terminated their insurance. Acturally, they would like to pay the amount they owed. However, the rep. told them contact the marketplace to deal with this issue. What do my parents need to do? If they cannot reenroll, what is the penalty?
My health insurance was cancelled because apparently the payment for my part of the insurance, although it came from the same place as one of my family members, went through a day or two late from what the woman on the phone had described to me. I’m without health insurance now and my family member has theirs. They still took the payment but would not continue to give me coverage. Now I have to go and call around until the issue is resolved. The woman also said that my insurance was cancelled in October, but I had a doctors appointment in the beginning of November which was paid for by the insurance company, otherwise they would not have seen me since they check my insurance before every appointment.
My mom paid all 12 months. Last year was a nightmare. She ended up owing the IRS for not having health insurance. Which she did pay all 12 months. Not to all so mention whoever sign her up at the market place sign her up for a family plan. She is a widow and lives by herself. This year again marketplace states that she did not pay for 3 months, still had her on the family plan. She paying over $500.00 a month. Again looks like we would have to fight with the IRS, marketplace and the insurance.
I insisted my insurance company pay for a test that I was covered for, after they initially declined to do so. Per the terms of my coverage, they eventually paid for it. As a result, they cancelled my coverage by way of “non-payment”… Simply by no longer charging my auto-pay option. No letter was sent, no phone call made, they simply stopped charging me. Like many people, I get most of my bills charged auto-pay, I’m busy, so I never noticed. After I discovered that my coverage was cancelled for non-payment, I contacted both my CC and my bank, there was no error on their part, the funds were available to my insurance company, they just never charged me. Now I am without insurance. It’s March, I can’t sign up until November. If I get hit by a bus and put in the ICU I could lose everything. All because my insurance company was upset I insisted they pay for something they were supposed to. How is there no oversight for this loophole? People should not be expected to constantly check to see whether or not their insurance companies are charging them, lest they get their coverage cancelled. And if one can show that the lack of payment was due to the insurance company purposely not charging them, then the insurance company should be forced to reinstate them.
I thought my premium was being automatically billed to my credit card, but only January was paid. Since I saw a doctor and got prescriptions filled in February, I had no idea there was an issue. The premium for silver coverage for my husband and I is $2300/month.
We received no notice that the premium payment had been missed and we were subject to termination.
On March 10, my husband went to see a doctor and we discovered the issue.
I’m a retired lawyer — FWIW here’s what I did:
1. Sent a letter of appeal on March 10 outlining our mistake and requesting reinstatement. Include your name, DOB, and policy number. Keep it short.
2. I tendered the full amount of the past due premium and the April premium by $7900 check. I will continue to tender the premium every month.
3. I emphasized that we had received no notice via any medium that we had missed a payment.
4. I explained that BC/BS actually represented our policy was in good standing by email dated March 14 entitled “Your Policy” which I attached to my letter. I pointed out that this was evidence that BC/BS actually had my correct email address.
5. I explained that BC/BS tacitly represented our policy was in good standing by paying the February doctor visit and prescriptions.
6. I enclosed a copy of the letter of termination dated March 10, received March 17 as evidence that BC/BS had my correct mailing address and is capable of mailing a notice.
7. I stated that we had reasonably relied on those representations to our detriment and that on the totality of the facts, BC/BS is legally or equitably estopped from asserting the policy is terminated.
8. I recited that we had no new medical conditions we were trying to get covered and that it had always been our intention to be continuously covered by BC/BS as we had been since our marriage in 1985.
9. I pointed out that, as they are aware, we are unable to purchase comparable insurance from any company at any price and that basic fairness dictates that the policy be reinstated.
Keep your submission factual, neat and organized. They don’t care about the minutia of your life.
I am NOT optimistic. I will be totally shocked if they reinstate us. I assume once they see my health history (breast cancer) they will go “YAHOO! Got rid of her!”
When that happens, I will buy catastrophic coverage for my husband. I’m not eligible due to cancer.
I will also file a lawsuit which I can do without it costing anything so what the heck — why not.
Until we spend $30,100 (premium plus deductible) we really haven’t been damaged so I look at it that we are self insured to that point.
I’ll post the results whenever I hear back. I was told 30 days.
This WORKED! I couldn’t be more shocked.
I can’t overemphasize the importance of tendering the premium. I haven’t actually received notice but they cashed the check.
Also focus on the facts that you relied on to your detriment like not receiving notice, receiving emails or mailings that suggest you are covered, not being notified when you are in the 30 day grace period and have a claim that isn’t denied, and keeping and submitting every single piece of correspondence that you receive from your insurer.
I have to admit that I walk several miles a day and my entire mindset has been focused on how to handle it when I was denied, and today all I could think was “thank you”. In my more extreme versions of what might happen, I determined I might have to divorce my husband of 32 years if that meant we had a life changing event that would trigger an enrollment period.
Good luck and DON’T GIVE UP. If you can’t pay it all, “tender” a check for what you can pay with the memo line reflecting that the payment is for reinstatement and a letter explaining your VERY SPECIFIC plan to catch up.
It’s not news exactly, but all they care about is the money. They could give a rat’s ass if you and your entire family perish from the plague from that rat’s ass if you can’t pay. You will never appeal to their human side ‘cuz they don’t have one
I was premature in asserting this strategy worked.
BC/BS did accept my three months of premium payments but asserts that those funds are “in suspense” and will only be applied to my account if my appeal is granted. BC/BS stated they have 50 days from the date of the appeal — March 24, same day they cashed the check — to determine the appeal.
I immediately wrote a letter which confirmed the conversation, tendered the May premium, and argued that in accepting the premium after the expiration of the grace period, BC/BS waived the late payment and/or is estopped from asserting the late payment as a basis for cancellation.
The letter also recited that acceptance of the May premium would be deemed an agreement by BC/BS that the policy has been continuously in force since Jan. 1.
THIS IS CRAZY. No notice, I’m throwing money at them and they are accepting it and that buys me nothing? It defies the laws of contracts.
Again, not optimistic but I’ll keep you posted.
Well, my strategy actually worked. I received a letter of reinstatement dated the 50th day after they logged my request.
I believe that three things were critical to my success:
(1) Paying the premium in full for three months and paying the fourth month whilst awaiting a decision;
(2) Asserting that BC/BS had waived and/or was estopped from asserting the late payment as a basis for termination by cashing my first check; and
(3) Reciting that by cashing the second check, BC/BS was agreeing that the policy was in full force and effect.
Act quick and pay up with the above language and you may have a chance! Good luck to all.
I dropped my daughter Ysha Anneaccount on February and I would to reinstate her account.
ReinState Affordable Health Care again.
My wife and split June 2016. She then dropped her hours at her employer ( this is where and how I was insured ) just below the limit to qualify for health insurance. Therefore my health insurance was terminated. I didn’t even know this for about two months when I went to use a prescription card. I contacted the insurance company immediately to find out why my insurance wasn’t working and that’s when I found out my policy was terminated June 1 of 2016.
Then they enrolled me in cobra. Reason I didn’t know I was canceled timely is because her employers cobra administrator sent all of the paperwork to my wife’s address therefore I was never notified of plan termination nor was I given any specific on cobra guidelines in regards to the law. FYI – when my wife moved out, I notified the HR department at her employer that I was at my address and my spouse was at a different address. All of my health insurance statements, example- explanation of benefits (EOB’s), we’re being mailed to her. Her employer refused and continued to refuse throughout my entire cobra participation to mail anything to me directly – they said everything had to be mailed to the employees address.
As mentioned, I finally was reinstated. Just a few weeks ago, the lady at my office who typically mails my premium to the administrator was on vacation. She neglected to mail the check. When she got back to the office at the end of June, I asked her if she had made the payment and she replied no.
I immediately went online and made an electronic payment for the premium Friday June 30. But, it was not posted to my account until July 5. Therefore I was more than 30 days late with the payment. Also on June 30 my office mailed a paper check and it took them until July 14 to post that to my account.
Regardless of these two payments and emails from them confirming the payments – they have terminated me retroactively to June 1.
I find this extremely unfair. Again, I was never given any paperwork from this administrator in regards to cobra laws therefore I was not aware of the fact that the 30 day grace period was enforced as strictly as it currently is. And again, I made an electronic payment on June 30 ( after 5 PM Eastern time ) and a paper check was mailed June 30. In other words on June 30 I paid for June’s premium electronically and a paper check was mailed for July’s premium.
They said, too bad, you’re canceled and there’s nothing you can do. They said I can file an appeal. They told me this three days ago. They said it will take 10 working days just to mail me the appeal form, he said it cannot be emailed. Once I receive that, they told me it takes 2-3 weeks for them to come to their decision. So, I’m not going to know the result of my appeal until the end of August approximately.
I take prescriptions that cost nearly $2000 per month if I needed to pay cash. There is absolutely no way I can pay for those prescriptions. Some of them are critically medically necessary!
I have no idea when I’m going to do until the end of August. And then if they decide to not reinstate me, who knows if I’ll be able to get another policy since the qualifying event of a ‘loss of coverage’ was technically on June 1, again I don’t even know if I will be able to another health insurance because so much time will have passed since the loss of coverage.
Feel free to share my story and any advice would be greatly appreciated. Thank you.
You have expanded appeal rights under the ACA. If you need to escalate to an external appeal then do so.
This doesn’t mean every situation is avoidable, but you have a lot of legal rights to place pressure in a situation like this. All those rights can expire quickly, so you always need to appeal ASAP.
Due to illness, a relative has been dealing w/ my mail. To my dismay, upon a MD’s appointment, I found out my plan had been terminated due to non-payment. My relative states “it just got by him and he is sorry”. What can I do ?
You can appeal. There is a window of opportunity that closes as time passes, so act and contact BOTH the marketplace and the insurer ASAP: https://www.healthcare.gov/appeal-insurance-company-decision/appeals/
one of my clients who has been a policyholder for nearly 5 years had her policy canceled by my company due to a bogus claim by the insurance company that an attempt for payment was made to her bank and the payment was not remitted. The bank responded by denying the insurance company assertion by stating, no attempts had ever been made to the bank to submit payment. furthermore, if an attempt had been made and the bank holder didn’t have money in her account, the payment still would have been paid since the bank holder carries a 1000.00 overdraft protection clause. In conclusion, the company merely canceled this policyholders insurance plan due to the fact, she had 2 surgeries for breast cancer and the surgeries paid out over 4000.00 which they feel is a risk of having more surgeries by the policyholder so they rid themselves of this risk. Here’s the caveat, the company policy states, regardless of age, health conditions, or the number of claims filed, the company cannot take your policy away…only for non-payment of premium. This is clearly a violation of their rule. And now, since this lady has had cancer which is in remission, she can not get insurance until 5 years have passed. Does she have grounds for a lawsuit?
Does she have a legitimate case for a lawsuit?
Well I’m not a lawyer, but a person certainly has rights in this case.
First and foremost they have to enter a formal appeal process immediately. As long as the appeal process starts within 30 days of “non payment” (or at least ASAP at this point), then the customer is following the rules and the insurer has to prove they did cancel the policy.
Second, I would not let them talk me out of this in any way, and if I had to I would go directly to an external appeal.
Third, yes sure, they could also seek legal counsel.
I let my coverage lapse by accident, but I didn’t realize that I had to try to get reinstated immediately. I made many phone calls to my insurers, but was never given this information.
Check out this page to see your appeal rights https://obamacarefacts.com/appeal-health-insurance-company-or-marketplace-decision/