Question:
does a lawyer know if my employer can change my plan in the middle of the year.
i started the lap band process in march and had everything done that was required then my employer decided as of 07012007 they didnt want to pay for this procedure anymore. is this legal?? — rams1967 (posted on September 4, 2007)
September 4, 2007
Vickie,
Without proper notification, I don't think it's legal for them to do that.
You might want to check with the state insurance regulators and see what
they have to say. If they are not changing insurance companies or plans
and have just decided not to pay for the procedure -- they need to have a
good reason why they changed their process.
— the7thdean
September 4, 2007
I'm not a lawyer but I think they are within their rights however, I do
think they need to give notice, how much, I'm not sure. Health insurance
costs are huge now and companies are trying to conserve.
— Sheri A.
September 4, 2007
This is something that is common and July is a common time for a plan
revision. Unfortunately one of the cost saving measures is to have have an
exclusion for WLS. There is nothing illegal about a plan revision, unless
the employer found out about the surgery and specifically changed
covereage. Good luck proving that though. There is something called
continuation of care that you may qualify for, at least with Aetna, you are
allowed to keep receiving services up to 3 months after a plan change.
Also remember that all things can be overturned on appeal. A well thought
out letter to the appeals department can go a long way. Another thing is
that with insurance companies, the squeaky wheel gets the grease, keep
complaining no matter how long it takes, be sure to exhaust all your
options. You have a good case, with already being approved and going
through the procedures, don't wait thought, time is against you.
— Jack_D
September 4, 2007
I don't know anything about how your state works. In WA, it's hard to find
coverage for WLS, period. And if you are a company of 50 or less people?
There IS no such coverage any more. I had the last plan in the state,,
paid thru the nose for it, too. My "year" rans from Oct to Sept.
We had a contract. I thought it was concrete. In July (that tidbit abut
July review makes sense here), they suddenly dropped WLS coverage. THEY
broke the contract, but I was stuck now with over priced ins that wasn't
even as good as what I'd get for cheaper! I had to wait til Oct 1 to
change to the better/cheaperplan. Better, as in it has more docs and good
benefits, as long as nothing happens to us WLS-related. While my DH &
I needed it for ourselves for our continued coverage, one of my employees
had an 18 y/o son, well over 500# and we were hoping to take care of him.
She dawdled and we lost the coverage. He is now about 23, and can barely
move. Long story to tell you that INSURANCE COMPANIES can do whatever the
heck they want and the employer may or may not (as in my case) have
anything to say about it.
— vitalady
September 7, 2007
Yes, its legal. I'm assuming you received some kind of notification or
else you wouldn't know about the coverage change. You may be able to
appeal the denial of WLS since you had already started and been approved
prior to the coverage change.
Good luck to you.
— mrsidknee
September 11, 2007
it shouldn't be legal... thats not right
— Kimberly F.
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