Hi, hoping someone can help me navigate this problem.

I had great insurance at my previous job, which I left in Jan 2021. My new job has insurance which is… Well, terrible. We are a small company so we outsource HR and benefits functions. I had tried to check all of my T1D husband’s required medications, doctors, etc before choosing to enroll with this insurance plan over a Marketplace plan. I was told by my HR contact that there was no way for me to check the drugs myself but if I gave her a list that she could check for me. She comes back and claims that everything is covered.

Well, come to find out the specialty drug the eye doctor injects during my husband’s treatments, which I was told is definitely covered, wasn’t covered. After 5 months of trying every way to get it covered I finally received the last denial of coverage yesterday.

Now, here comes my question. I’ve already checked on Pennie and found Marketplace plans which cover this drug. Is there any way for me to get to the special enrollment period now instead of waiting for open enrollment? I’m the only employee that actually uses this plan, so my thought was to ask my employer (who already knows of the struggles and is open to making the situation better) to terminate the health coverage through the third party service, in the hopes that this would count as a QLE and allow me to switch to a Marketplace plan now instead of waiting.

Any thoughts or suggestions?? I just feel absolutely terrible about this. My husband is still getting treatment but now he goes every 4 weeks instead of 8 weeks and loses a day of work each time for the procedure.

See also  Denied claim