My Partners plan was cancelled because of insurer’s own errors. What are my options? Details below

My (M36) partner’s (F34) insurance was canceled this year due to an unpaid premium balance.

We get her insurance through the marketplace. In 2023 we decided to go from her current silver level to a gold plan on the same provider. She has several chronic health issues and a lower deductible was worth it. Apparently, the way this is done is the silver account is closed and the gold is opened as a new account. This will be important later.

In Jan of 2024 we received a bill for $400 but when we logged into her account to pay the amount due it said $0.00 paid in full. Odd. We call the insurance company and they tell us that we are in fact paid in full. No action needed. Still sus but ok.

This same cycle happens in February 2024. $400 bill. Website says $0 balance due. We call. Confirmed nothing is owed. Concerned still but ok.

In March 2024 we get a call from her hematologist informing us that her insurance has been denied and the coverage has been canceled thus we owe in full for her last blood draw. We try to log into the provider’s website and cannot access anything. Freak out time.

Apparently that $400 bill was some small dividend from the 2023 silver plan and for whatever reason they couldn’t see the balance when we called. I suspect it’s because it was technically an entirely different account due to the upgrade process?

We try to pay the $400 and just move on. Request denied. Account is closed. Coverage is over.

Seems like a fairly easy appeal to make. We request all the call logs available to support our written appeal but conveniently those logs no longer exist. Plus, whoever we spoke with on the phone did not mark any notes on the calls. I suppose, to them they simply got a phone call for a bill that was $0. Not noteworthy. Thus no paper trail.

We filed the appeal regardless and waited the requisite 8-12 weeks. (Eye-roll.gif) In the meantime we put her on a month to month disaster coverage and she has stopped seeing her specialists until we get this sorted.

DRUMROLL PLEASE… THE RESULTS OF THE APPEAL ARRIVED!

Today we were informed that our appeal has been denied.

I don’t know what the next step should be. I don’t know who to call. I have a suspicion that the next time she applies for insurance her premiums will be quoted MUCH higher because she has been terminated by previous provider.

Any advice would be GREATLY appreciated. Also I’d love to know if we are screwed for finding her coverage in the future or will it be insanely expensive? Should we contact a lawyer possibly?

Thanks in advance and I appreciate you reading this novel.

submitted by /u/TwoSeam
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