I have a bisalp surgery scheduled for next Friday (8 days from now) and it was supposed to be completely covered/reimbursed through my health insurance. I have Cigna through my employer in the state of Florida. I have paid for and completed all of the pre ops and appointments out of pocket with the expectation of reimbursement from my doctor's office once the procedure is completely finished. I paid out my new year deductible yesterday to cover the provider fee.
I got the email TODAY that I have been dropped from my employer's insurance for being a few hours short of full time last quarter. I have been assured by my boss that I will get my full time hours by next quarter and I will be re enrolled in our benefits.
I plan on contacting my surgeon and surgery center tomorrow to see if they can push the surgery back 12 weeks or if I'm going to have to start from scratch with the appointments. If they can just push it back then I won't have to worry about trying to get all my money back for a surgery I didn't have yet and reimbursement for the appointments.
I also wanted to know if I was going to have to l go through a waiting period after I got back on my health insurance before I qualified for surgery. I was informed that even if I got enrolled in a private or marketplace plan and had no gap that I would have a waiting period of at least a month. I didn't know if it was the same for insurance I was already on. Finally, I wanted to know how the deductible works. Is it the deductible for the year or am I gonna have to pay out the deductible again once I'm back on the insurance?
Thank you for any help. This is my first time dealing with insurance as an adult and it's been an absolute nightmare and I don't have a ton of people to ask. (I will be calling insurance and doctors tomorrow to get details, I just want to get a gist of what I'm working with).
Dropped from my employer's insurance 8 days before major surgery
byu/plantmama104 inInsurance
Posted by plantmama104
8 Comments
there’s a lot to respond to on this, try asking chatgpt/gemini/etc as a starting point.
if your employer is over 20 full time equivalent employees you’ll have a COBRA offer. ask HR if your employer uses a measurement or stability period under ACA.
edit: jesus fucking christ with the downvotes you guys. you just want professionals with decades of experience to show up, read through, assess, and respond to a complicated situation for someone that self-admittedly has little experience with ‘adulting’ and insurance and educate them on everything from the basics on up? fuck it, i’m out.
LLMs/AI can answer the basics so that a human can be better utilized explaining nuance. ffs.
I would personally ask the insurance company that question about the lap in coverage. I know for myself when I ended up going on cobra I didn’t have a lapse in coverage and I was in the middle of medical treatment so I would have known. But your best bet is to talk to insurance company they will have that answer for you
You have 60 days to enroll in COBRA after your employer benefits end. You do need to find out when they ended but if it was as of 1/1, you can get coverage retroactive to 1/1. COBRA isn’t cheap but it’s better than a pile of unpaid hospital bills.
>I paid out my new year deductible yesterday to cover the provider fee.
That’s not how it works, your deductible is met as claims are processed, you cannot “prepay” your deductible.
There is no waiting period to go on COBRA and it will be retroactive back to the date you lost your coverage. Kicker here is that you will receive COBRA info within 14 day of either the date your employer notified insurance of your loss of eligibility or the date you lost coverage, whichever is later. When providers run your benefits for the surgery, I doubt it will be reinstated within 8 days for COBRA given USPS and admin processing time.
COBRA will have the same deductible, but I’m not quite sure what will happen upon your eventual reinstatement.
Hey, I’m leaving this here to help others, even if it currently doesn’t apply to you.
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If you paid your insurance premium this month, your insurance will last until end of the month. If you got laid off, your insurance doesn’t end there and then. At least if you are in CA.
COBRA should be all you need. It means that your insurance doesn’t officially lapse. Just make sure you enroll soon.
COBRA immediately.