Husband’s employer didn’t keep up with premium payments, we haven’t received notice of cancelation and all claims are being rejected.

TLDNR: My husband’s insurance is paid for by his company. The company hasn’t kept up with the premium, and now all claims are being rejected. It’s been months, and we still haven’t received notice of cancelation so I can’t enroll us in new insurance. What can be done?

We live in Ohio and have Anthem Blue Cross Blue Shield insurance through my spouse’s company. He is a co-founder, and handles sales/marketing, while his founder is the CEO and handles the financial side of the business, including HR and benefits. He is the insurance admin as well.

The past year has been a rough one financially, and at some point early this year, the CEO stopped paying the health insurance premium without telling my husband. I was pregnant at the time, and we didn’t find out about this until about a week after I had given birth (in mid-March).

I immediately called contact Anthem and asked if my insurance was active, explaining what I knew about the situation, that I hadn’t been notified of any cancellation or lack of coverage, and wanted to know if my recent hospital stay and birth would be covered. I was told that my coverage was “Active, " meaning I still had insurance (I have a transcript of this conversation). I get information on how to add our son to our insurance and add him without issue.

Knowing what was coming, I asked my employer's HR department about switching to their health insurance. They say I can as soon as I receive a notice of cancelation. The notice of cancelation never comes. I check my insurance portal frequently, it still says “Active.” We go to the pediatrician for checkups. I get mastitis twice. We get prescriptions filled. I see a lactation consultant for feeding issues. I buy a breast pump. Our Anthem insurance was presented before these visits without issue.

Fast forward to May and I started getting hospital bills, which was expected, but they are showing insurance covered 0% of the bill. I spoke to the hospital’s billing department, and they told me that insurance has rejected the claims and that I am responsible for the whole bill. I spoke to Anthem, and they confirmed that they will reject any claim moving forward and that I have several past claims that will also be rejected. The reason for rejection is due to non-payment of premium. I explained I couldn’t pay the premium, my husband's employer pays for it. How could I pay it? I’m not the company, I'm just on my spouse's insurance. That’s not their problem.

As of now, his birth and all of the appointments since have been rejected and I’m being billed for the full amount of service. I have no idea how I will pay these. I still haven’t been released from the insurance, meaning I can’t switch to a new plan through my employer or until open enrollment, which is months away. So my son, and my husband and I look like we are still covered by Anthem, but have been told all claims will be rejected until the premium is paid.

To this date, no one who works for the company or any of the employees has been notified of the cancelation.

So my questions are, what can be done? Is this just a failure of epic proportions on the part of the CEO? Or did Anthem’s system mess up along the way? Can we hold them accountable for the information conveyed to the people it was supposedly covering?

My husband is becoming the insurance admin to try and resolve this, I’m not sure if they will ever be able to pay the premiums owed. There seems to have been a failure on Anthem’s part to cancel our insurance, even now we still show active in their system. However, all claims, for all employees in the company, keep being rejected. How can he approach the insurance company and get us out of this hostage situation, and, hopefully, get some sort of reimbursement?

I wish he could just quit, but there is company debt he is responsible for and the best chance of pulling the company out of this mess is if he sticks with it. At the moment I’d settle just getting on new insurance through my employer, but I still have no idea how I'll afford the bills that are stacking up.

Thank you if you’ve read this far. It’s a confusing and stressful situation to be in and I just want to keep my family safe and afloat. I love my husband, but my priority is making sure my infant son gets medical care and I can financially take care of him. Any advice is appreciated, and if you have questions I’ll do my best to answer them.

submitted by /u/itllbefineok-
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