In Bureaucracy, Business, Law, Law Enforcement, Social commentary on January 6, 2016 at 1:58 pm

An insurance company suspends your medical coverage for months—or longer.

You’ve faithfully paid all premiums for your medical insurance—and have the records to prove it. But the company doesn’t care.

Think it can’t happen to you?  It did to a couple I’ll call Diane and Mike.

Mike worked as a paralegal for a Los Angeles law firm. He was getting health insurance for himself and his wife, Diane, under a COBRA arrangement.

COBRA stands for Consolidated Omnibus Budget Reconciliation Act of 1985. It’s a Federal law that was passed by Congress and signed by President Ronald Reagan.

One of its provisions creates an insurance program giving some employees the ability to continue health insurance coverage after leaving employment.

But a COBRA can sometimes act the same way the deadly poisonous snake does—with unpredictable and lethal results for those depending on it.

In this case, after Mike left his law firm to work at another, he found the COBRA didn’t operate as it was supposed to.

A snafu developed, involving

  • the COBRA management company,
  • the hospital where Mike and Diane had long been patients, and
  • Mike’s former employer.

Each of these institutions blamed the other for failing to provide appropriate information.

So the insurance company suspended Mike and Diane’s health insurance–completely ignoring their medical needs.

Of course, for most people who have dealt with an insurance company, this won’t come as a surprise.  Insurance companies aren’t in business to do good. They’re in business to make money.

Then, one day, Diane called me on an unrelated matter. During the conversation, she let slip the suspension of her medical insurance.

I was stunned at the news–and outraged when she said this had been going on for six months.

At once, I offered my services as a troubleshooter. She accepted.

I decided to call the office of my State Assemblyman. In California, the 80 members of the Assembly serve two-year terms, and are limited to being elected three times.

The 40 members of the State Senate serve four-year terms, and can be elected twice.

Because they face re-election sooner, members of the Assembly must stay closely attuned to resolving their constituents’ problems. That’s why they employ staffers who are experts at navigating through the maze of State agencies.

California State Capitol Building

And State Senators make certain their offices are equally well-staffed with such experts. 

When I called my Assemblyman’s office, I didn’t ask to speak with him. I knew I was too politically unimportant to rate a direct chat at that level. And I didn’t need to talk with him, anyway.

I simply told the secretary that I wanted to speak with the office’s specialist on insurance.

California has an Insurance Commissioner who directs the state’s Department of Insurance. The mandate of this agency is to license, regulate and examine insurance companies.

Soon I was speaking with Frank, the Assemblyman’s expert on insurance matters. I quickly explained the problem my friends were having. And, to my surprise, I found that he and I hit it off right away.

Frank said he had a friend–Steve–who worked as an investigator for the Department of Insurance. Then he generously offered to put me through to him. I thankfully accepted.

Soon Steve and I quickly found ourselves getting along well. Then he asked me: “What’s your friend’s number?”

Diane hadn’t authorized me to give her number to anyone, but I decided to forward it. If Steve was that interested in examining their problem, I wasn’t going to throw a damper on his enthusiasm.

Soon Steve and Diane were discussing the situation.

The insurance company Mike and Diane were relying on was, like many such companies, registered in Florida.  But, in order to legally do business in California, it had to obey the laws of the State of California.

And California laws forbade exactly the sort of behavior this company was engaging in.

And shortly after that conversation, Diane’s insurance company got an unexpected call from the Insurance Commissioner’s office.

The message was simple–and blunt: Restore that coverage–now.

And, within 48 hours, it had been fully restored.

There are several important lessons to be learned here:

  • Maintain accurate records of all your premium payments. And keep them accessible–as in file folders, a safe deposit box or an online file.
  • Don’t let your insurance company victimize you. Once you’ve paid your premium, you’ve lived up to your part of the arrangement. Now it’s their obligation to provide the medical care you need.
  • Know the names, addresses and phone numbers of your representatives–at local, state and Federal levels. Websites such as http://www.govspot.com/ and http://www.capweb.net/ will instantly provide this information–and a great deal more.
  • Know the name, address and phone number of your state Insurance Commissioner.
  • If your elected representatives can’t or won’t assist you, complain to the news media. Start with the local newspapers and TV stations. If that doesn’t work, try the Internet.
  • If the agencies that are supposed to help consumers won’t aid you, make them part of your complaint to the media.
  • If you’re disabled and/or have children who are affected by the insurance cut-off, play up this angle in your contacts with public agencies and/or the media.
  • If all else fails, consider filing a lawsuit against the insurance company.
  1. Everything is very open with a clear clarification of the issues.
    It was really informative. Your site is useful.
    Many thanks for sharing!

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