Health Insurance heads up when your child turns 19

Parent Cafe
1

<p>All,</p>

<p>I just thought I would post information about a situation that happened to us this week with our son who recently turned 19. He is covered under husband’s health insurance plan, has his own card, etc. </p>

<p>He had a routine appt with a specialist that required a referral number from his PCP. When I called to get the referral, his PCP office referral manager routinely looked up his/our insurance information. Lo and behold, to her astonishment and mine, it showed that he had been terminated from our plan! In essence, he was uninsured and we had no idea that anything had happened! As a matter of fact, had he not had this appt to go to, he would have gone on being uninsured and no one would have been the wiser (until he needed medical attention I guess). </p>

<p>When I called Anthem’s Member Services, they said that it was a “system error” and because he had turned 19, he was terminated from our plan. We never received any paperwork from them for anything. Fortunately, with a call and email within their offices he was reinstated on our plan and now will receive a new card. </p>

<p>I don’t know if this has happened with others or other health care companies, but I just thought I would pass it on to possibly alert other parents. It could have been a mess of a situation had he needed medical care at college.</p>

2

<p>We’ve had all sorts of trouble in a similar vein regarding our health and dental, and there really has been no valid explanation.</p>

<p>With our dental, I went to a scheduled appointment with my mom’s dental card. When they ran my insurance, they said that I wasn’t covered because I had turned 19 and my mom hadn’t completed the paperwork. We called her at work, and she was livid, because she had signed up for the dental plan when I was 19 already. There was no way they could’ve terminated my coverage for that reason, and she had specifically filled out information regarding my attending college.</p>

<p>Then, after that was cleared up with the dental, a few weeks later I had a doctor’s appointment for routine physical and a couple tests that women will be familiar with. About a week later, I got the bill for everything, including the appointment and lab tests above and beyond our deductible. My mom had updated the paperwork, even, but when she called the insurance company, they determined that the plan was somehow backwards and terminated children at 23 and students at 19, not the other way around. Long story short, I guess the lesson learned here is we can’t assume that our insurance company or place or work hasn’t screwed up somehow with the paperwork. In our case the company has realized their error and will be picking up the tab for what it should have covered.</p>

3

<p>Insurance companies typically remove dependents at 19 unless you tell them they are still eligible.
Usually a phone call to your benefits manager will result in quick reinstatement back dated to the termination.
Normally they do send out a letter.</p>

4

<p>Unfortunately this is all too common with many medical plans. And I really, truly do “feel your pain” as I am still trying to straighten out this very same problem out with our own insurer!</p>

<p>Just last Thursday I received a form letter that stated it was intended to serve as our “certification of prior insurance coverage with CIGNA HealthCare, as required by HIPAA (Federal law) when an individual loses health coverage.” As I looked down the list of items (many of which were left blank, as they apparently were not applicable), I fell off my chair when I came to:</p>

<p>“4. NAME OF ANY DEPENDENTS TO WHOM THIS CERTIFICATE APPLIES: XXXX
and
10. DATE COVERAGE ENDED: 03/31/09.”</p>

<p>Now this form letter was dated July 24, 2009 – nearly 4 months after the termination occurred! We had no inkling that he was no longer covered – and had not been covered for a very long time! And the form letter gave no indication at all as to why his coverage had been terminated. We eventually figured it out because March was his birthday month and he had turned 19.</p>

<p>To make matters worse, the letter said to call 800-XXX-XXXX “for futher information.” But when I called that number, I heard “Thank you for calling CIGNA Healthcare. The number you have called is no longer operational.” What??? The letter was dated just 3 days earlier and they had disconnected the phone number in that time period?!!</p>

<p>So I called our normal “Member Services” number and talked to a very nice lady, who of course had no idea what I was talking about because the letter was generated by “a different department.” And the only number SHE had for that department was the 800 number that was no longer in service! Finally, after being transferred to several other people in various other departments, I was told to send in “proof of his full-time student status” to a certain fax number, which I did. But I still have not received any acknowledgment that they received it or that they have restored coverage, although I have repeatedly called back. </p>

<p>Since they were obviously tracking my son’s age (as they immediately knew when he turned 19), it would have been very easy for CIGNA to just send a letter back in February or March indicating that coverage was going to expire due to his age and giving us a chance to either submit proof of his student status to continue his coverage or to at least know that we needed to find him some other health insurance if he was not a full-time student. That would have been fair. But if not for HIPAA, we wouldn’t even know now that he had no coverage, because the Federal law was the only reason they had sent out that letter.</p>

<p>And of course, CIGNA has continued to bill us for my son’s coverage each month – and still does! Even though he is not covered…</p>

<p>What a mess!</p>

5

<p>Wow! I feel lucky. DH’s benefits department sent him an email warning him that S would lose his coverage when he turned 19 unless we confirmed to them that he was a full time student. So DH wrote back to his benefits department and told them that S was a full time student enrolled at XYZ college. And that was it - no problems since, and S is now 20.</p>

6

<p>JustaMomof4, They did reinstate him with bc of my phone call then their email but the point is he was terminated without any notice and it was an error on their part. I am thankful we luckily caught it rather than having to deal with the headaches and paperwork for the correction of any future medical bills or procedures.</p>

<p>Under our HMO plan (through a large school system) the dependents are covered until age 23, not 18. We were aware of that fact and that is what took us by surprise. All I know is that when my daughter gets to 19 I will give member services a call with our policy number
just to check and make sure this same error doesn’t occur again. And hyperJulie, after reading your post I think I need to call our dental plan carrier to see about his coverage there- thanks for the reminder through your post!</p>

7

<p>We’ve never had any trouble like this. My friend had to send in verification from the college…class schedule,proof that tuition was paid…every year that her D was in college.</p>

8

<p>KandKsMom - you should call your benefit manager. Tell that person what happened.
My plan covers until age 19, unless they are full time students, occassionally this happens.
The ins co is supposed to send a letter out prior to the birthday.</p>

<p>It is a good idea for parents to be proactive and notify benefits of their childs student status. I wouldn’t even go through the ins company, make your benefit dept do it.</p>

9

<p>I would definitely enlist the help of your HR department. I believe that under COBRA regs, the plan administrators are supposed to notify anyone who is being terminated within 14 days and offer continuing coverage. </p>

<p>About 10 years ago, one of my children became very ill and was hospitalized. We had no idea that our family insurance had been terminated when my husband went out on a temporary workplace injury which required surgery. The company originally refused to pay for my daughter’s care but I knew we had never been properly notified/offered continuing coverage as the law requires. I had my attorney send them a letter and they promptly paid the expenses we would have been entitiled to. Since then, Michelle’s law has also been implemented which precludes carriers from terminating coverage for college students who lose their full time status due to illness.</p>

<p>[FAQs</a> For Employees About COBRA Continuation Health Coverage](<a href=“http://www.dol.gov/ebsa/faqs/faq_consumer_cobra.HTML]FAQs”>http://www.dol.gov/ebsa/faqs/faq_consumer_cobra.HTML)</p>

<p>[Michelle’s</a> Law Provides Extended Medical Coverage For Students](<a href=“http://www.ogletreedeakins.com/publications/index.cfm?Fuseaction=PubDetail&publicationid=822]Michelle’s”>http://www.ogletreedeakins.com/publications/index.cfm?Fuseaction=PubDetail&publicationid=822)</p>

10

<p>Our insurance company just plain stinks. I could cite chapter and verse regarding our many struggles with them on this and every other customer service issue. When our oldest d turned 19, we received a letter saying that she was no longer eligible for coverage. Now, our contract stated that she was eligible up to age 25 as long as she was a full-time student, but the letter made no reference to the contract. No mention of continued coverage for enrolled dependent students, not even a phone number to call with inquiries. Just bingo, she’s out.</p>

<p>So we call the insurance company and they tell us to submit proof of enrollment in college, which we do by sending them a copy of her bill noting our full payment. This is immediately followed by the exact same letter stating that d is no longer eligible for coverage because she’s 19. Call the insurance company again. This time we’re told to send proof of her enrollment from the registrar (?). Which we do. This is immediately followed by the exact same letter stating that d is no longer eligible for coverage because she’s 19. You can bet we called the insurance company again. This time they wanted the bill, the registrar’s information, and a copy of her birth certificate. Following receipt of this and an extremely unpleasant encounter with my husband, insurance company finally agrees that the kid is covered.</p>

<p>My favorite episode came a couple of years ago when d2, then a sophomore in college, had to pay out of pocket for a prescription at her local drugstore (900 miles from home), where she was told she was no longer covered. After a protracted and agonizing encounter with a supervisor (who reprimanded me for becoming impatient after 45 minutes without an explanation), it turns out that every year, as dependents over age 19 approach their birthdays, they’re “taken out” of the system and then manually re-input once their student status has been confirmed. So I guess we were doubly fortunate that d was simply picking up her usual medication and not attempting to access an emergency room with a serious problem the week before her birthday.</p>

<p>I’d bet my house that our insurance company’s poor customer service is expressly designed to discourage customers from receiving the benefits to which they’re entitled. This opinion is born of 20 years of constant aggravation - phone numbers that are no longer in service, claims that are denied for the hell of it a couple of times before they’re paid, epic waits on hold while the rep actually handles other calls. </p>

<p>Excellus Blue Cross Blue Shield. They are vile.</p>

11

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</p>

<p>Talk about hitting someone when they are down!</p>

12

<p>frazzled1:</p>

<p>No wonder you’re frazzled! :eek:</p>

13

<p>Off Topic Warning:</p>

<p>

what’s up with that anyway? what happend to customer service and the customer being right? UGH. </p>

<p>Michelle’s Law - if memory serves me correctly, Michelle was a young woman who had cancer and stayed enrolled in school to keep her insurance - even though gravely ill.
sad all around and a good law, IMO.</p>

14

<p>I know we had to call our insurance company when S started college. They just needed a phone call, nothing in writing, but the only reason I knew to contact them was because I had heard of a similar situation as the original poster’s problem.</p>

15

<p>Isn’t it funny how insurance companies continue to collect the full premium even though someone has been “dropped” from the coverage?</p>

16

<p>My son is now turning 23 (late August) and he’s no longer a full time student. We were told his insurance is being terminated by BCBS. However, it was relatively easy to get low cost insurance for him in my state. He is healthy and young…just wanted to tell people about this. It is easier to get low-cost insurance in some states than others.</p>

17

<p>Wow, once again, I feel I have a good insurance plan. The HMO sent us a form in August asking whether Ss were going to be full-time students and where. And that was is. Students remain on their parents’ plan until 24.</p>

18

<p>thank you OP and worried_mom for these warnings. D just turned 18 and is about to start college, so we are a year away from all this. but we have CIGNA so I am marking my calendar a year in advance and alerting H (insurance is through his employer) so this doesn’t happen to us. many thanks for the heads up!</p>

19

<p>We also have CIGNA and have always received a letter asking for verification of continuing FTS status a few months before the kids would become ineligible and annually thereafter, without prompting. Our policy covers kids through the end of the calendar year they become 19 so the letter always arrives in late Aug/early Sept. To verify FTS status we need to either submit a copy of their class schedule, tuition bill or letter from the college. We’ve never had a problem and students can be covered through age 26!</p>

20

<p>my-3-sons, you are really lucky because you seem to have a much better CIGNA policy than we do. Is yours through an employer? I am self-employed, so we have an “independent” family plan, and as I posted, there was NO advance notice that coverage was being dropped. If not for HIPAA, I’m sure we STILL wouldn’t know that the money we are paying to cover my son is being totally wasted.</p>

<p>What’s really baffling to me is that the MEDICAL service we have received from CIGNA is first-rate. We’ve been with them for 29 years and have had some truly great doctors. We have absolutely no complaints in that area. But its CUSTOMER service stinks!!!</p>