ANSWERED: What can I do if my health insurance company makes a mistake and terminates my coverage?

It can happen to any of us. You make your payments every month, and then one day you go to the doctor, and they tell you that your medical insurance has been terminated. So now, on top of what you were originally going to the doctor for you are suffering from cardiac arrest. What should you do?

Gather Proofs

The first thing to do is to gather up your proof of payment information. If you paid online, try to locate the confirmation email. Also, look at your bank account and make sure that the payment was deducted from your account. If it was, the date of withdrawal could be helpful when you contact the insurer.

Occasionally, especially if you pay by check, a payment can get lost in the mail, or there might be an issue with your bank that causes the payment not to get through. If this happens, you can use the check number and date that you mailed it to support your request to have the policy reinstated.

Call Your Insurer

Next, you should call the carrier and explain the situation to them. Make sure to have all of your proofs when you call. If the termination of coverage was due to their error, it should be fairly easy to get them to acknowledge the mistake and reinstate the policy.

If, however, the issue that caused the termination is that your payment never arrived or the company did not debit it from your account, you can likely get the policy reinstated, but you will have to pay the past due and current premiums.

Tip: Don't wait too long after you learn about the termination of coverage to contact the carrier. The longer you wait, the less likely the carrier is to reinstate the coverage. In fact, if you wait too long the company may not be able to reinstate the policy even if they wanted to.

Reinstating the Policy

In today’s technology-based world, reinstating insurance coverage is easy as pushing a button. Keep in mind that it can take up to 48 hours for your coverage to show as active. If you need to see a doctor or other health care professional before the policy shows active online or via the insurer's automatic telephone system, you can ask the doctor to call the carrier and coverage can be verified.

What if the Insurer Made a Mistake But Still Won't Reinstate Coverage

Sometimes, even when you have properly articulated to the carrier that a mistake caused your policy to terminate, the insurance company may still refuse to reinstate your coverage. "How could this happen?", you might be wondering. Well, sometimes that representative that you are speaking with may not understand the mistake. Others may be confused about their ability to reinstate a canceled policy while a handful may just be doing it out of spite because they didn't like the way you spoke with them.

In this scenario, you have two primary options. Option 1 is to contact an attorney. Of course, you will likely have to pay the attorney to take action on your behalf. In some instances, you might have no other option but to retain an attorney.

Option 2 is to contact your state's department of insurance. In New Jersey, insureds can contact the NJ Department of Banking and Insurance and file a free complaint against their insurance company. The link to the website is: http://www.state.nj.us/dobi/consumer.htm#insurance

In General, the NJ Department of Banking and Insurance is very good with assisting consumers. The will contact you fairly quickly and do all they can to get the carrier to reinstate coverage. All insurance providers in New Jersey are regulated by the Department. If these companies act in an unfair or illegal manner, the State can fine them and in extreme circumstances, even restrict or revoke their license.

It Happens

To say it is "frustrating" when mistakes occur that result in the cancellation of your health insurance policy is a massive understatement. However, it happens, and the only thing you can do about it is to follow the steps above. The worst thing to do is to let your emotions take over. Acting out of emotion will cause you to say things that you probably don't mean and lose focus on the facts that can help you get it reinstated.

If you would like more information about this topic or have general legal questions, please feel free to contact me at (201) 904-2211 or via email at pl@pjlesq.com. We answer legal questions on a daily basis and would be happy to discuss any issues or questions that you have with you. #askpjlesq © 2017, Law Offices of Peter J. Lamont & Associates. This Update is provided for informational purposes only. It is not intended as legal advice nor does it create an attorney/client relationship between the firm and any readers or recipients. Readers should consult counsel of their own choosing to discuss how these matters relate to their individual circumstances. This Update may be considered attorney advertising in some states. Furthermore, prior results do not guarantee a similar outcome.

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