A COBRA worse than snakes, Part 2

As I said yesterday, being told by my COBRA administrator that they’d retroactively terminated my health coverage back a month and a half, to five days before I had surgery, was one of the worst things ever to happen to me.

I mean—in the cosmic scheme of things, it’s not as bad as, say, being bombed out of my home or having to plan the funeral of a child or grandchild. I recognize that—it’s only money. But it was a whole lot of it, it was unexpected, and I felt like an idiot for not having noticed that one of my premium payments hadn’t been applied.

Also, Towers & Watson, the COBRA administrator, did everything they possibly could to stonewall me. No individual I could discuss the situation with; nothing but a PO box and a phone center number.

Their “notification” of termination was as close to stealth as it’s possible to get—an ordinary “Certificate of Group Health Coverage” notice. Nothing indicating that this was something completely out-of-the-ordinary. If I hadn’t had a pharmacy question a week after receiving that notice (sent to the wrong address to further delay my receipt), I wouldn’t have known there was a problem until the period of appeal had expired. (I had to throttle the information out of them that I had 30 days from the date of that Certificate of Group Health Coverage notification to file an appeal.)

Even their appeal denial letter had no signature. Just:

Now, keep in mind that, although the denial was postmarked 23 January, one business day after I spoke with their rep on the phone, it was actually dated 6 January. Meaning two days after they logged my actual appeal into their system on 4 January. So I wondered how it was possible that anyone had engaged in a “thorough review” in two days, as their denial stated:

(Also, please note that final sentence; I’ll return to it later.)

I expect that the only thing that got reviewed was the cost-benefit analysis that determined that if they upheld the termination, they’d save themselves $100,000.

At any rate—before I actually received this letter, I’d blurted out my predicament to MDC, the leader of a careers workshop I’m taking. I hadn’t intended to do that, because I felt so sick about the whole thing. But for some reason, I did.

We were at a Saturday morning career support meeting sponsored by the Menlo Park Presbyterian Church. MDC immediately said, “Let’s talk to AH.” He’s the executive director of the organization. AH said, “The best thing is probably to see if a lawyer will take this on pro bono. Let me make some phone calls.”

I didn’t see how a lawyer would help, but I did feel somewhat better knowing that a couple of people who really know how to make things happen thought I should be entitled to help. They both thought this situation was inherently wrong; MDC actually said, “They did wrong by you.”

On Tuesday 24 January I picked up a voicemail from a woman, RN, who works for an insurance organization. An attorney AH had contacted had forwarded his email to her and within three hours she’d reached out to me. When I spoke with her she absolutely hummed with both energy and outrage. Although she’s VP of business development for an insurance brokerage, she took down my story, rooted out a contact at the US Department of Labor and drafted a letter for me to email to this guy to get him on the case.

RN contended that no employer wants the DOL on their back, and an inquiry by them would elicit immediate attention and rectification by the corporation.

She contacted me the next morning—before 0800—to make sure I’d received her draft and to give me guidance on how to get in touch with the DOL guy. At that point I still hadn’t received the denial letter from T&W, and she wanted me to get my email off before that came, to reinforce the idea that they’d been negligent in sending me any communication.

I have to say that I didn’t see how a bureaucrat was going to help. I mean, my former employer, the decision-maker in this process, snacks on the SEC and DOJ and it bitch-slaps the EU’s European Commission. However, I PDFed all the correspondence I’d received up to that time from the administrator and emailed it all off to ET at the DOL.

It was a bit of a shock to get a call from him the next day. I mean—we are talking the federal government here, the wheels of which grind exceedingly slow. He took down some information and told me he would contact the employer—he doesn’t mess with the administrator or the insurance company. The employer is the responsible party in these things; especially in this case, as my ex-employer self-insures.

I was a little downcast, as ET didn’t seem to be able to make it through the corporation’s phone tree. He called me the following day to say he couldn’t reach the office of the General Counsel (RN said that the corporate counsel would really take notice of a call from DOL). I went online to Hoover’s and found the VP of HR (or “Chief People Officer”—like that makes a difference) and the VP for employee benefits. He said he’d speak with someone there and “have them do some research.”

A couple of days later RN sent me a document that outlines federal regulations for the employer’s responsibility in COBRA administration:

Now, this was a massive surprise to me because the COBRA administrator’s whole point in the termination was that it was up to me to ensure that they received full payment and they weren’t obliged to notify me that there was any problem. To wit:

 

Well—so maybe just because they said they didn’t have to notify me doesn’t mean that in fact that was true? That they were just saying that to, um, defraud me?

The following week, ET contacted me to let me know that he was in touch with a person at the corporation’s benefits department. She was “doing some research” on my case. I asked what, exactly, that meant. He replied that she needed to research “all records of payments” to see if they could find out what happened to the April one, verify whether they accepted all my payments subsequent to that but didn’t notify that it was missing.

I liked the way that was headed, so I let him carry on.

And then, on 9 February, ET called again. I was still at the stage where I hated hearing the phone ring, dreading that it might be medical providers wanting to know where their payments were. ET said that this benefits woman had left him a voice mail saying they’d sent me a letter and she was faxing him a copy of it, but he hadn’t received the fax, so did I have the letter.

Well, that morning I’d actually found an envelope from the COBRA administrator in my mail box (sent to the wrong address again, & forwarded), but hadn’t wanted to look at it. However, with ET on the line, I ripped the envelope open and found that on 3 February they’d grudgingly decided…well, let them say it:

Now, this “explanation” they were accepting would be the same one they’d rejected less than a month before. So I knew it was the inquiry by the DOL that caused the turnaround.

They said that if they received premium payments for November and December (they claimed they’d refunded the latter, though more on that later) by 3 March they’d cover me for that period. They didn’t say where to send the payment and I hadn’t actually received a refund. So I had to call the T&W number to find out the particulars from Latayia.

And it turns out that, although their letter of 6 January said they’d processed a refund for December’s payment, they had in fact not even requested a refund until 8 January. And “it takes six to eight weeks for that to be processed.” So more prevarication from them.

However, rather than expect them to draw the logical conclusion, or conversely to risk them finding another excuse to deny me coverage, the next morning I sent them full payment, via registered mail. I figured I’ll get the overpayment back later.

The payment was signed for at 0333 on 14 February, and the check cleared my bank on 15 February. (So—they can actually move in a timely manner when it suits them. Or when they think the DOL is watching.)

Last week I checked with the insurance provider. Their rep told me that they showed there’d never been a break in coverage. In fact, he said, I’m still covered.

Uh, no; coverage ended 23 December. Oh. Um.

Anyhow, I spent 27 minutes on the phone with Roy at Premera Blue Cross, going through every claim from the November/December coverage period. Every one has been resubmitted, although he did say it could take up to 30 days for that. So I’ll be checking back, since I’m taking nothing for granted now.

Yesterday ET, the DOL guy, called to see if the claims have been paid. Seriously—follow-up from the fed! RN has also checked in—and she was absolutely ecstatic when I called with the reinstatement news.

I feel so fortunate in the sequence of events since that awful Friday when T&W told me I was stuck for all the bills. People I barely knew stepped up for me, guided me to people who could put pressure on my ex-employer and get them to do the right thing. My providers are going to be paid what they expected to be paid. I’ve had a dreadful weight lifted from me.

And I’ve learned my lesson about checking that payments have cleared.