Question:
employer deceided to stop coverage mid year any recouse?

I was i nthe process to have the surgery. the local Dr. lost his insurance. I went to HR to find out how to go out of network to have the surgery and was told as of Aug 1st this is no longer covered. it is August 31st and the employees have not been told. a letter is coming out i nthe next couple of weeks. my employer has decedied to exclude it because it was costing too much money. Do I have any recourse?    — Ding_ah_ling (posted on September 1, 2005)

September 1, 2005
I work at a unionized workplace and I'm not really sure what recourse you have, but I would imagine that an employer must notify the employees there is a change in the insurance plan BEFORE the change takes place, not after (you may be able to check on this with your local labor board in your city). If you have other medical problems because of obesity - heart disease, diabeties, sleep apnea - you can try to appeal their decision, because then the surgery would be a life saving procedure and not cosmetic - which the employer probably thinks it is, otherwise they wouldn't have cut it from the insurance plan. Good luck in your fight.
   — nan c

September 1, 2005
If was the typical re-enrollment period all insurances have, there is a good possibility that when if they changed contracts or if they dropped certain coverages you may not be notified. Unfortunately, most insurance companies put the onus of notifying employees of changes of coverage on the employer since the employer is the person who decides the coverages. I would speak again to your HR person and you can also check with the Insurance Commissioner of your state and see if proper procedures were followed in notifying employees of the changes. I would also contact the employment commission of your state and see if this was handled correctly. These agencies may not be able to help you, but they might be able to direct you to someone who can answer your questions. Best wishes.
   — Shayna T.

September 1, 2005
You might have a chance if you request the surgery, are denied and then appeal. Most insurance plans have a little statement somewhere in the policy that says they can make any changes to the plan at any time without notification.
   — koogy

September 2, 2005
not sure if cobra can help but its a shot
   — ROSEMARY A.

Click Here to Return