Insurance company issue

Hello ATS, I'm wondering if anyone has some advice on how to deal with a problem I've been having since the ACA was implemented.

[backstory]
Back in 1998 I was employed at a small retirement home, as an assistant kitchen manager for the old folks who lived in the facility.

I left that job and went to another, but while employed we had health insurance, "Company A" we'll call them for intents and purposes.

Now, back in 2003 this retirement home left insurance company A, and went with another carrier.

[Current events]

Now, for the last 10 years I've been on my spouses, we'll call them "Company B" insurance. But over the last 5+ years, I keep getting dinged with being told I'm double covered through Company A.

I haven't paid a premium to Company A since 1998, but I am still listed. I've called company A for a "Coordination of Benefits" and basically am told I am a ghost in the system, they can't remove me because of Federal Law only the original company can. However, the original company doesn't have an account with them any more, and they can't get their liaison to do anything either.

Insurance Company B is refusing to pay stuff now, because of Company A having me on their records.

Anyone have any idea how I can get this resolved?

I've gone so far as to have both companies and the Auditing company for Company B on the line all together, and it keeps pippin up every couple months.

I need this resolved, permanently. Ideally, with Company A removing me from their system.

Man that's a tough one. I don't have any advice but I'm interested in what a solution for this would be. Hope someone around here can offer you some help

a reply to: Cygnis
Get a lawyer, and sue them.

I'm sure they will, A. pay all the insurance claims you've had, or B. Immediately find a way to get your ghost out of the system.

If you're like me and can't afford a lawyer, send them a registered letter saying that either remove your name and information out of the files or you will take immediate legal action. Sometimes, a lawyer will do this for a small fee and it will carry greater weight.

a reply to: Cygnis

Send insurance company A a medical bill.
They will figure it out in a hurry.

originally posted by: Bluntone22
a reply to: Cygnis

Send insurance company A a medical bill.
They will figure it out in a hurry.

The problem with that idea is, I have no group policy #, and no UID to send it in to them with.

It's just my name and my SS# in the system. No benefits, no coverage, nothing.

But the Auditing company is able to pull me up with those two tidbits, and claim I have coverage.

a reply to: Cygnis

That is strange, I would contact a lawyer in your case.

Good luck to you.

a reply to: Cygnis

But the Auditing company is able to pull me up with those two tidbits, and claim I have coverage.

I don't know any better; but with that answer that I quoted above, I would then ask the auditing company;
If you say I am covered then 1- I'll need documentation confirming such-including the information needed to file my claim--->
I'm busy trying to get healthy.

I'm of the opinion that insurance is a racket until proven otherwise.

originally posted by: Cygnis

Insurance Company B is refusing to pay stuff now, because of Company A having me on their records.

Anyone have any idea how I can get this resolved?

You need an official letter from Company A declaring you don't actually have coverage with them. If they have your name in their system, they must explain why they are holding your particulars. Send that to Company B, with a letter of your own explaining the situation.

There's one thing that is certain, if you're not paying premiums to A, you're not covered by A. If you're paying premiums to B, then B must cover you. All insurance cos try to weasel out of any obligations whenever they can, and "pass the buck", so you have to make your case very clear, collect the documents that prove you're not paying A but paying B.

Document, write them letters to get the details down on paper, mail it so they get it (registered mail best). And that itself should do the trick.

originally posted by: Cygnis
Hello ATS, I'm wondering if anyone has some advice on how to deal with a problem I've been having since the ACA was implemented.

[backstory]
Back in 1998 I was employed at a small retirement home, as an assistant kitchen manager for the old folks who lived in the facility.

I left that job and went to another, but while employed we had health insurance, "Company A" we'll call them for intents and purposes.

Now, back in 2003 this retirement home left insurance company A, and went with another carrier.

[Current events]

Now, for the last 10 years I've been on my spouses, we'll call them "Company B" insurance. But over the last 5+ years, I keep getting dinged with being told I'm double covered through Company A.

I haven't paid a premium to Company A since 1998, but I am still listed. I've called company A for a "Coordination of Benefits" and basically am told I am a ghost in the system, they can't remove me because of Federal Law only the original company can. However, the original company doesn't have an account with them any more, and they can't get their liaison to do anything either.

Insurance Company B is refusing to pay stuff now, because of Company A having me on their records.

Anyone have any idea how I can get this resolved?

I've gone so far as to have both companies and the Auditing company for Company B on the line all together, and it keeps pippin up every couple months.

I need this resolved, permanently. Ideally, with Company A removing me from their system.

Section 1002 of the ACA calls for the establishment of state offices of health insurance
consumer assistance or health insurance ombudsmen. Call your state Department of Insurance and they can put you in contact with the proper office.

a reply to: Cygnis


This happened to me, years after I got divorced, and changed companies twice.

I called ex husbands company, explained what was going on and they sent me a letter stating I was no longer covered by their insurance, which I then made 4 copies of, and sent certified to new companies Insurance. It took many phone calls a certified letter and a good cust service rep (always get name) to resolve it.

Good Luck! If company is out of business you can print info from a simple google search; last years tax returns can prove it too (who you worked for).

a reply to: Cygnis

Only thing I can think of is did you carry over some extended benefits from the 1st place? That would get you stuck re-instating, and renewing over and over again. That would do it if you had received benefits carried over from the 1st....but thats an awfully long time for that....and not likely.

Good luck and let us know how it worked out. Some of us here could benefit from anything you do learn!

Best

originally posted by: mysterioustranger
a reply to: Cygnis

Only thing I can think of is did you carry over some extended benefits from the 1st place? That would get you stuck re-instating, and renewing over and over again. That would do it if you had received benefits carried over from the 1st....but thats an awfully long time for that....and not likely.

Good luck and let us know how it worked out. Some of us here could benefit from anything you do learn!

Best

Nope, none at all. In fact, back then after that I went 9 months without any insurance (for better pay) until the new place I went to laid me off and shuttered its operations.

I will defiantly update things as they go.

Currently have an appointment with a lawyer through my spouse's work tomorrow.

a reply to: Cygnis

Call an attorney!

I work in a pharmacy and have dealt with insurance companies and trouble shooting billing rejections. I have seen similar problems to yours. It usually takes the patient months to resolve some patients have been dealing with it for years. Medicaid, Tricare and Medicare are especially bad for this (notice they are tax payer supported programs).

They third party "customer advocates" will pass you around like a blunt and they will play stupid with you every time.

You need legal advice.

a reply to: Cygnis

It does sound incredibly messed up and confusing for you. Most folks got issues with just 1 insurance comp..... And here you're trying to figure wth is going on with a couple! I hope you get it sorted out.

I really believe some of these companies are out to mess with us... Good luck.

And may the force be with you on this one!