Grace Period and Review of Cancellation
Grace Period and Review of Cancellation
Gather documents, cancelled checks, warnings, late notice, emails, phone logs
Gather documents, cancelled checks, warnings, late notice, emails, phone logs

Did the Insurance Company meet the Legal Requirements
to cancel your policy for Non – Payment of Premium?

How might I successfully file an appeal?

Alicia J says:

I had coverage beginning on March 2014 through BCBS Texas. I then used the marketplace for insurance through BCBS Texas. I paid my premiums. I went to several doctors during the time I had insurance.

I got a refund check in the mail the other day. I thought it was weird so I called BCBS and they said it was a refund because I was late on a payment. I never received a cancellation letter. If I had I would not of been sending my premiums every month. When I would go to the doctor I was never informed that my insurance had been cancelled. I never received bills from them either so that gave me no indication that my insurance had been cancelled. They said they realized this after they had an audit.

Don’t know what to do at this point.  I would not of gone to the Dr. had I known I didn’t have insurance.

Any suggestions would be appreciated.

 

The specimen policy on page 39 deals with grace periods. The policy says may terminate, rather than shall. That’s in your favor. Of course, I’m not an attorney and am unauthorized to advise on contract law.

I think you are going to wind up in a he said, she said situation with proving or not proving that late notices and your premium payments were sent or not sent.  Were your checks cashed?

What dates does Blue Cross say they sent you late notices? US Mail or Email?  What proof do they have they sent them.

According to the policy, you lapse 30 days after the late notice, not 30 days after premium was due.

See page 151 for more information on how to file a grievance.  The policy says that you must provide ALL pertinent information and the details and circumstances of your concern or problem.

As an authorized agent, we help our clients with filing appeals, reinstatements, communications problems as a complimentary service as we are paid by the Insurance Companies to consult, enroll and service our clients.  Here’s instructions to appoint us in CA.

I just received a notice that my Anthem (non-exchange) policy was terminated because of lack of payment for February. I filed an appeal based on the fact that I thought that auto-payment had been set up.

Anything else I can do?

Will they reinstate my policy?

What documentation do you have to show that you had cause to think the auto pay was set up? Think of an appeal as a court case in front of an Administrative Law Judge. What evidence do you have? See our appeals page. If Blue Cross says no, do you have enough evidence to take this issue to Department of Managed Health Care?

The Blue Cross manual makes lapsing for non-pay look like a black and white issue of no reinstatements.

What does your Blue Cross Member portal show?

Do you have a copy of the automatic premium payment form that you filled out? Proof that you sent it? Proof Blue Cross rec’d it?

What about the alternate ways to pay premium?

There are always temporary plans.

Do you have an special circumstances to qualify for a special enrollment?

  •  Anthony says:

    Thank you for your response. I don’t have any documentation supporting my assertion that I thought I had set up autopay.
    I thought I set it up online in the same area where monthly bills are paid.
    The tab concerning payments on the Anthem site is not available anymore.

    Any advise as to whether it is worthwhile to ride out the grievance process or should I move on to other options? One issue with that is I have a number of claims that have now been denied because the termination was effective Feb 1.

    Any idea what they look for in an appeal? Is it a mere formality?

    •  Steve Shorr says:

      There aren’t really any other options. One plus in Health Care Reform is no medical questions, guaranteed issue and no pre-existing conditions clause. The downside is one can only enroll at certain times.

      I’m not an attorney, near as I can tell an appeal is like an informal court case. I suggest you prepare your appeal in the same manner. Here’s the small claims court manual on how to gather the documents you need.

      When were you notified of the termination? That might get your claims paid?

      •  Anthony says:

        I requested the Anthem agent to submit the info for my appeal/grievance in hopes of expediting the process. Based on what you have stated I may have been to simplistic in my grievance. Basically I said I thought I was in autopay and received no notice that the payment for February was past due. My first knowledge of the problem was when I received the termination letter. Hopefully they give me an answer within a couple days (they said that is possible)

        Termination letter was dated March 6. The denied claims are before that date.

        •  Steve Shorr says:

          Do you mean the customer service representative or your agent, which doesn’t cost anything extra to have?

          See beginning of this page for information on how and what is needed to file an appeal.

          We are talking about February payment right? If it’s January it looks like you’re SOL as the grace period only applies after you’ve made your first payment. Things are really complicated under Health Care Reform. The policy says you shall be informed that you can apply for reinstatement with a new application, BUT they only take applications at Open Enrollment and Special Enrollment. Then it talks about your right to have the cancellation reviewed.

           

          Have you received confirmation that they are handling your grievance?

          On the other hand, since you don’t seem to have any documentation to prove your case, it appears you’re SOL. You might contact an attorney? Maybe there will be a class action lawsuit somewhere. However, Health Care Reform seems to allow cancellations. It’s the only underwriting left for the Insurance Companies…???

          Here’s Kaiser Foundation on late notices…

          BC/BS New Mexico

Related Pages in  Grace Periods? NEVER get cancelled Non-Pay!!! Section

Appeals & Grievances

3 comments on “Was the cancellation legal? Web Visitor Q & A

  1. Found your name on website of anthem…..We have lost our coverage due to exceeding grace period time frame…..DEVASTATING….Anthem is going through process of reinstatement application but informed me it does not look good. Is their any hope? My husband and I are 61 years of age. what can we do? We pay $1,980.00 monthly in premiums.

    • Thank you for our conversation by phone this a.m. Please e-mail me whatever documents that may be able to assist me in getting reinstated with Anthem Healthkeepers Gold Richmond VA under Blue Cross Blue Shield

    • Do you qualify for any special enrollment periods?

      How about a temporary plan? The time periods for coverage have become very limited though.

      Didn’t you get a late notice?

      Personally, I don’t like submitting appeals and grievances over the phone. You don’t know if the person taking the grievance really knows what they are doing or are looking out for your best interests. I suggest you put everything you have together and file your own grievance. Then if you get denied, you are all ready to give it to your attorney or the appropriate state agency to help you.

      So, basically, read everthing I have and follow the links in this section of the website and put together your best argument.

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