Your Opinion

[SamIam]

I have a client that we submitted a short term plan with one of the major carriers. The checking account was entered wrong so they canceled the policy. Me and the client called them and told them what happened and asked if they can reinstate the policy and they said yes and it's on tape recording. Two weeks later the client had a hernia and the carrier sent a claim form to fill out. Now the carrier is saying they aren't allowed to reinstate short term plans even though they withdrew funds from the client six months draft over a month ago.

I believe they should be responsible because they told the client yes they would reinstate it and took the money. Plus if they told us no we would of just reapplied and have coverage.

They said they will review the tape. I think this is B.S. What is your opinion.

 

[Yagents]

I have a client that we submitted a short term plan with one of the major carriers. The checking account was entered wrong so they canceled the policy. Me and the client called them and told them what happened and asked if they can reinstate the policy and they said yes and it's on tape recording. Two weeks later the client had a hernia and the carrier sent a claim form to fill out. Now the carrier is saying they aren't allowed to reinstate short term plans even though they withdrew funds from the client six months draft over a month ago.

I believe they should be responsible because they told the client yes they would reinstate it and took the money. Plus if they told us no we would of just reapplied and have coverage.

They said they will review the tape. I think this is B.S. What is your opinion.

You're screwed. The client screwed you too. Hernia's are something that someone "feels" and can live with for months. It's probably the only reason he wanted an insurance plan. There are waiting periods to cover hernia's, even on pre-obamacare underwritten policies, and I'm sure STM policies too. The only policy that would have covered it is an ACA policy.

Net net - the carriers' not going to cover the claim.

Your best bet is to try and get a full refund, or pro-rated refund.

 

[SamIam]

Let's say it wasn't a hernia, lets say they broke their arm shouldn't the carrier be responsible since they said they would reinstate the policy?

 

[AllenChicago]

if it was injury related hernia, such as lifting too much weight after the effective date, it might be covered.but if there is no clear indication or date hernia actually occured, the company will not pay the claim regardless of the policy being reinstated. That is one of the main shortcomings of short term health insurance.

 

[Yagents]

Let's say it wasn't a hernia, lets say they broke their arm shouldn't the carrier be responsible since they said they would reinstate the policy?

If it wasn't a pre-ex condition, and it's not a condition that has a waiting period, and is a covered benefit, and if you have a time/date/name or confirmation number of the conversation, then you have a fighting chance.

You said Hernia, what actually happened? I can only give direction with facts

 

[FLM2]

If it wasn't a pre-ex condition, and it's not a condition that has a waiting period, and is a covered benefit, and if you have a time/date/name or confirmation number of the conversation, then you have a fighting chance.

You said Hernia, what actually happened? I can only give direction with facts

It was actually a heart attack caused by a hernia

 

[SamIam]

It was a Hernia and I get what your saying. My main reason for the post though was if BCBS told us they would reinstate the policy which is on tape and took the money, sent the claim the client a claim form don't they have to re-instate the policy? That's really my main question. Because they are saying they don't re-instate short term plans but they will review the tape.

I understand if they don't pay the claim because maybe it was a pre-x.

 

[leevena]

I have a client that we submitted a short term plan with one of the major carriers. The checking account was entered wrong so they canceled the policy. Me and the client called them and told them what happened and asked if they can reinstate the policy and they said yes and it's on tape recording. Two weeks later the client had a hernia and the carrier sent a claim form to fill out. Now the carrier is saying they aren't allowed to reinstate short term plans even though they withdrew funds from the client six months draft over a month ago.

I believe they should be responsible because they told the client yes they would reinstate it and took the money. Plus if they told us no we would of just reapplied and have coverage.

They said they will review the tape. I think this is B.S. What is your opinion.

As much as you will not like this answer, it appears that the carrier is not required to reinstate. Sorry.

The fact that the carrier cashed the check does not bind coverage. The fact that a representative said they would reinstate does not bind the carrier either.

 

[rugerred]

As much as you will not like this answer, it appears that the carrier is not required to reinstate. Sorry.

The fact that the carrier cashed the check does not bind coverage. The fact that a representative said they would reinstate does not bind the carrier either.

Isn't payment of the policy the final piece to the contract?

Sent from my Samsung Galaxy

 

[AllenChicago]

are there federal or state laws that govern this type of thing, or is it entirely up to each company whether or not they want to reinstate the plan, or pay the claim, even though they accepted the check?