Guest guest Posted November 13, 2002 Report Share Posted November 13, 2002 Daryl, Martha is right. COBRA is federal law. If your employer didn't notify you about coverage loss, and how to continue insr, they have broken the law, just as I stated in my message to you. You would have a very solid case if they didn't notify you. And again, Martha is right about coverage being effective through the end of the month. Rarely you will lose your insurance prior to the end of the month. However, even if that is the case with you, this still puts you at a disadvantage because if your coverage ends on Nov 30, your surgery is in Dec. You actually have 60 days in which to elect COBRA. Your coverage will stop until you pay the premiums, but all your medical bills will be covered retroactively as soon as you pay the premiums. However, you have Great West, and this is the company I'm suing in federal court. Great West is an EXTREMELY unethical and corrupt company. So, it is imperative that you document, document, document with them because if they can get out of paying a claim, they will. I strongly encourage you to do some research on this because federal law mandates that your employer notify you of your coverage termination and your options to continue (COBRA) including premiums, date due monthly, and whom to send the payment to. Please call me when you get my message! e ----- Original Message ----- From: MARTHA Sent: Monday, November 11, 2002 4:03 PM Cc: Daryl Subject: Re: My Explant Hi Daryl, Please immediately check with your insurance company, ot your Plan Administrator, to see if your premiums were paid for the month of November, as premiums are normally paid the first of the month by your company. If so, you should have coverage until the end of the month. You should also receive a Cobra notice to be able to continue your coverage by paying the premium yourself. You also have at least 30 days to elect Cobra coverage, which is required to be the same coverage you have at the time your other coverage ceases. Cobra Coverage is mandated by ERISA, federal law! Please let me know! Thanks, Martha Martha Murdock, DirectorNational Silicone Implant Foundation | Dallas Headquarters"Supporting Survivors of Medical Implant Devices"4416 Willow LaneDallas, TX 75244-7537 ----- Original Message ----- From: Daryl Sent: Monday, November 11, 2002 5:02 AM Subject: Re: My Explant I finally got an appt. with Dr. Huang in Denver in Dec. and have been so excited about it. My Ins. was approved and Marie and e will be there with me. Sounds great right??? Well, I'm a flight attendant for National Airlines here in Las Vegas. Without any warning we went out of business 3 days ago. Now I have no Ins. at all. My husband called the P.S. office and they said it would be $8000.00 for explant and lift. If we can borrow money from family or credit cards I can still have the surgery. I am kicking myself that I didn't have the implants out a few weeks ago! Anyway, now I'm desperate for advice on how to try to keep the cost down or if anyone knows a dr. just as good as her who is more reasonable. Is $8000 the going rate? Do they give us a break if we don't have Ins.? I would think so. I'm really down about losing my job and my health Ins. Am I going to be able to get new Ins. with all my health problems? Any advice would be great! Love, Daryl LM Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 13, 2002 Report Share Posted November 13, 2002 Martha, It really doesn't matter that Daryl's problem is ERISA related. When you are covered under an ERISA plan, you basically waive your rights to everything related to the insurance company. What I'm trying to say, is that yes, it is her inherent right to have her premiums paid through Nov 30, and it is her right to have her medical claims paid for in the interim; but unfortunately, some employers and some insurance companies don't follow the law, and as a result, put innocent people in an ugly position. I am suing this same company for violoting federal statutory law; for not paying claims according to their own plan provisions, and several other things. But you know what? When I sought out attorneys to help me, they were few and far between (just like you said). And why? Because ERISA laws suck for the public and we basically throw all our rights out the window when we accept coverage through our employer. And there are few attorneys out there who want to or are willing to challenge ERISA laws. I searched all over for an attorney in Tucson who would even give me the time of day. And now that I've moved back to Denver, I've had to find an attorney here to help me. I got lucky and my rheumy here in Denver gave me his name, and he's young, aggressive, and hates insurance companies. What's more, he reviewed my case, and lucky for me, strongly feels that this company has broken more than 1 federal law. So, what I'm saying is that Daryl does have legal recourse especially if her employer didn't notify her as mandated by federal law. In this instance, she is not really dealing with the insurance company, but her employer and federal law. Furthermore, while she should have coverage through Nov 30, she still has her explant scheduled for Dec and it will be very hard for her to reschedule her explant to occur within the next few wks, esp with Thanksgiving coming up. In addition, she still has to get precert/preauth, and if her employer didn't pay premiums for Nov, then she's technically not insured. Even though her medical claims would be paid retroactively if her premiums are/were paid, the fact that she has to get precert/preauth for this procedure pretty much renders her helpless. The insr company (esp this one) could put off approving (or denying) the surgery until Nov 29, then give her a denial, all the while Daryl will have been waiting and then be denied 1 day before her coverage expires. If she doesn't get precert/preauth, then chances are the surgery will not be covered or covered at a very poor percentage. So, she's in between a rock and a hard place. I have strongly suggested that Daryl do some research on the above to see if perhaps her employer did send her a notice of termination of coverage, and she misplaced it or accidentally threw it out; or if indeed they never notified her. I do believe that Daryl has spoken to this company and they have told her she no longer has coverage, which indicates her premiums have not been paid. It is not as easy as saying she is covered and getting her explant is no problem. There are several federal and legal implications involved here, not to mention financial implications for her, and she needs to proceed with caution so as to not jeopardize her chances of having this surgery covered (even if it is retroactive). However, I do strongly feel that she needs to be somewhat aggresive in finding out what happened with her employer and resolving this issue ASAP. e ----- Original Message ----- From: MARTHA Sent: Tuesday, November 12, 2002 2:28 AM Subject: Re: Fw: My Explant Dear LM, I'm certain you meant well, however, your advice to 'contact an attorney' was an over-reaction to the problem. The Federal ERISA Law of 1973-74 takes care of these situations, and ERISA attorneys for individuals are very hard to find. Most of them all work for large corporations! When you 'kids' do not know the absolute correct answers to questions or problems, you should not be embarassed to say, "I don't know!" And, obviously, none of you do know the answer to this situation! I do! MM Martha Murdock, DirectorNational Silicone Implant Foundation | Dallas Headquarters"Supporting Survivors of Medical Implant Devices"4416 Willow LaneDallas, TX 75244-7537 ----- Original Message ----- From: perlesetlacet@... Sent: Tuesday, November 12, 2002 1:05 AM Subject: Re: Fw: My Explant Martha:Thanks for trying to help Daryl. The thing is (without getting too personal), some of Daryl's former coworkers have spoken to attorneys about this situation but where told there was nothing they could do b/c the airline in question filed bankruptcy. I urged Daryl to contact an attorney anyway--just to know for sure.Don't worry, somehow, some way, we'll get Daryl the surgery she needs--I'm committed to it!Take care,LM Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 30, 2003 Report Share Posted October 30, 2003 Take it easy, Deb. Rest, and take care of yourself. I am so happy for you! Sending gentle hugs - ----- Original Message ----- From: Deborah Levy Sent: Thursday, October 30, 2003 4:13 PM Subject: My Explant Dear Ladies:I had my explant on Wednesday and I am doing well. I wenttoday and got the drains removed and Dr. Melmed showed me what my new breasts look like. I am very small and the top isquite flattened but will hopefully improve with time. He toldme that I had very little breast tissue and he was concerned but I look much better than he expected.I'm feeling pretty well to have just had surgury so I'm hopefulthat this too will improve.Debbye Quote Link to comment Share on other sites More sharing options...
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