Cobra Appeal

sonny

Have an ee out on LTD. Notified yesterday that his coverage has been cancelled d/t not payment. EE has developed dementia, all kinds of memory problems. His young daughter is trying to help him with his affairs, she said she watching for but never got bills, or he may have thrown them out. We called CobraServ to try and get some assistance from them as to how ee and daughter can appeal. We were told the ee has no appeal rights, but that as an employer, we can write a letter of support/appeal, although there is no guarentee it would help. Have any of you written this type of letter and if so, what was the content and were you successful? Thanks in advance. I do not normally deal with COBRA but was delegated this one so need HELP.

bsa

[font size="1" color="#FF0000"]LAST EDITED ON 09-13-02 AT 04:00PM (CST)[/font][p]I tried to find it, but couldn't and I may be suffering the same as your ex-ee, but I thought I read about a case similar to yours where the courts decided that insurance had to be re-instated. ???any idea... any attorney???

Why is CobraServ the final decision maker? Will they defend [u]you[/u] for their decision in front of a jury and pay all expenses & fines? I am not usually an alarmist, but they made a decision for you that affects you.

NaeNae55

I am sure I heard of a case where the ex-employee was given extra time by the courts because he could not take care of business in the normal time period. Don't remember the details, but if the employee can prove that the dementia is the reason for non-payment and that the problem has been solved for future (bills to be sent to relative who will handle), the courts will likely hold in the ex-employee's favor. Tread carefully.

sonny

I was a bit manic the day I was trying to handle all this. . After the fact i did a search of our very own Forum and found some more info. The thread was Cancelling coverage of Cobra paricipant and Don D had talked with Kim Green. . She mentions Sirkin Phillips College, Inc."the grace periord is extended if the beneficiary is mentally or physically unable to make a timely payment" Moneyman's response was also helpful and apparently a lot of the issue. The letter we got in response to our request noted we "may be obligated to others (who were cancelled) so that they maybe treated in the same manner." which was Moneyman's point. Our attorney is looking into it. Thanks, the Forum comes through again.

Lair

We wrote a letter of support due to "mental confusion" to our insurance company at COBRASERV's suggestion. The insurance company approved and coverage was granted. Regarding contents, we just indicated that we, as plan sponsors, were in favor of granting coverage because the individual had been diagnosed with mental problems which caused confusion and had been unable to to make a timely response.

Don D

We just signed on with Cobraserv. Besides deducting a 2% admin fee from every cobra premium check, I'm wondering what it is they do for us. Since we are self insured, they would not be able to dictate to us what we might do. On a similar note to yours, I have a friend whose mother apparently cancelled her (the mother's) cobra insurance 2 years back. She is Altzheimer's diagnosed and all it took was a few calls to the carrier (a state employee plan) and a letter from her physicians to establish that condition and its timeline. They went back and grandfathered the grandmother, reinstated her coverage backdated 24 months, picked up and paid all the prior medical bills and charged her the back premiums. The daughter now handles the business side of it for her. All told, the lady realized $3000 more in payback than the amount charged for the back premiums. So, there ARE things that work when there is an equal amount of will and effort. A good rule of thumb is 'don't ever accept as final the first answer you get regarding insurance'.