Double Health Insurance Nightmare & Potential financial ruin ... Please help with advice

cavediver

New Member
5
Hi people,

I’m dealing with some nightmarish health insurance issues that could financially ruin me, and was really hoping to get some advice here of steps I could potentially take to fix it.

Location: Colorado

I'm going to detail the scenario below:

- I'm employed with employer “A” and insured through our United Health Care insurance
- My wife worked employer “B” and is also insured through my “A” UHC insurance
- My wife also has a Kaiser Insurance policy for free from her employer that we do not use because the benefits and deductible are terrible, which is the reason why I added her to my plan
- I selected UHC to be the primary insurance for my wife during election time but we did not cancel or make changes to her Kaiser as we were told that it was free for us

During the coverage period, my wife has been to the doctors several times and always used UHC. United contacted us and asked about who the primary insurance is and we stated that it was UHC since it is exclusively what we are using.

Now we are starting to get phone calls from doctors and notices stating that UHC asked the doctors to return money to them for claims as there is the other insurance coverage. We have already paid all the out of pocket expenses (deductible) to UHC.

All the doctors that my wife went to are not Kaiser doctors (Note here that for Kaiser you need to use specific Kaiser doctors and usually get referrals), but UHC network doctors - however UHC is asking us to submit all claims to Kaiser which Kaiser is going to reject since we didn't go through them.

I'm pretty rattled by this as I figured that when I pay the insurance premium and fully ensure my wife that these things are covered but now it sounds like that in the very best case scenario I'm at least responsible for the Kaiser $6,000 deductible or worst case for all health care expenses over the past 2 years which I estimate to be over $120,000, either way, this is a massive financial burden for us I was trying to eliminate by having insurance in the first place - I'm shocked that this can happen since insurance is supposed to cover these things.

I hope that one of you can help me out with the next steps to take for this. I'm a European national living in the US and don't fully understand how this system works as they are so vastly different from what I'm used to.

Thank you in advance!
 
Sorry to hear your situation. Unfortunately, based on what you have outlined above, it appears that the carrier is following the correct procedures.

The coordination of benefits rule, for this scenario, is that your wife’s plan is primary. These rules are set, you do not choose which plan you would like as primary.

You can appeal, and people will encourage you to do so, but short of new compelling information, your appeal will be turned down.
 
I'm sure they are following the correct procedure, I'm just completely at a loss how I'm going to get out of this mess ... When I started adding my wife to my insurance plan I thought it would be a good thing but now I'm stuck in this crazy mess ...
 
Again, may be missing some info. I would stop her participation in Kaiser. Then work on payment plans for providers.
 
Lee provided an accurate answer based on the information provided.

You have combined what appears to be a PPO plan (UHC) with an HMO (KP). The money you paid for double coverage did not achieve what you expected.

I'm at least responsible for the Kaiser $6,000 deductible or worst case for all health care expenses over the past 2 years which I estimate to be over $120,000,

Frankly, I am a bit surprised it took providers this long to discover the problem. It would be highly unusual for KP to agree to cover the expenses since they were legally the primary carrier and it appears the providers your wife used were out of network.

Try to work out a repayment plan.

Good luck.
 
Countless times I have met with clients who think they have double amount of coverage, or ask if they can keep their employer plan and pick up an mapd. It doesn’t work that way and can create a huge mess.

It stinks it happened to you but that’s why everyone on this board makes money. To make sure our clients don’t do this.
 
To be fair, group health open enrollment advice is sketchy at best and most of the time the employer recycles information provided by carriers.

Added in is the fact that few people bother to read the material.

A few years ago the SHBP (state health benefit plan) which covers 10 million people made a change in coverage for active employees and early retirees under age 65. All the copay plans were eliminated and replaced with high deductibles.

Not until we were a few months into the calendar year did teachers and other employees complain. When they finally USED their plan and discovered they no longer had a copay there was an uproar. Complaints continued and even made the news.

The state gave in and changed 1 or 2 plans to a copay RETROACTIVELY to January 1.

What a waste of time and money because (mostly) teachers failed to read the benefit summary.
 
Countless times I have met with clients who think they have double amount of coverage, or ask if they can keep their employer plan and pick up an mapd. It doesn’t work that way and can create a huge mess.

It stinks it happened to you but that’s why everyone on this board makes money. To make sure our clients don’t do this.

I wish our benefits coordinator would have that info ... I'm trying to contact her and ask for advice navigating this issue but all she response is that I cannot make changes outside of enrollment periods which has nothing to do with what I'm asking help with ...

Do you have any advice how to best start cleaning up this mess? Call both insurers and figure it out, get a lawyer, trying to get a court order or something similar to get her Kaiser insurance to post-term coverage?
 
HR will be no help as you have already surmised. Few HR managers can even spell COB much less explain it.

The carriers have already reacted accordingly. UHC is in the process of trying to recoup monies paid. KP is simply shrugging their shoulders and saying it's not their problem . . . which is true.

Perhaps your best bet with the carriers is to ask UHC to readjudicate the claims as a secondary payer . . . which is what they should have been doing all along.

That will probably still leave a big gaping hole of unpaid debt.

I would be surprised if KP paid anything at all on review.

The only helpful advice you may get from a lawyer is how to file BK.
 
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