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Re: Re: Forced to be "Out of Network"

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Posted by Craig (68.8.206.163) on July 14, 2003 at 19:57:44:

In Reply to: Re: Forced to be "Out of Network" posted by Fin Keegan on July 14, 2003 at 16:40:14:

Fin

Your COBRA benefits should be the same as your group health insurance benefits, so there should be no exemption for COBRA. It sounds like they really want to make an exemption for an expensive pregnancy.

You will need to contact a department of labor investigator to resolve this.

Craig

: Sorry: my EMail below is incorrect: it should be "fjk4@columbia.edu"not "fjk4@columbia.edi" /Fin

: : My wife and I discovered shortly after moving to Nevada from New York that she was pregnant. Since we have access to COBRA and, now, a "pre-existing condition" (the pregnancy) no local insurer will touch us. So, we are forced to use COBRA.

: : However, since my former employer in New York pays for a NY-NJ-Connecticut Network POS plan we are deemed "out of network" every time we incur medical costs.

: : There is a provision in the POS plan paid for by my employer that allows for "guesting" of family members on networks elsewhere in the country e.g. the Nevada network.

: : However the insurance company refuses to allow my wife to guest on their Nevada network because we are on COBRA. As a result we stand to incur several thousand dollars worth of out-of-network (coinsurance and deductible) expenses when my wife has her scheduled C-section in August. This is on top of the $1000 per month we are paying the insurance company through COBRA.

: : My question in this: apart from any humanitarian or common-sense considerations (which I know are immaterial to the corporate parties in these situations--I merely mention them because we happen to be human beings not money-trees) surely we are being discriminated against by virtue of the fact that we pay through COBRA?

: : If so, does not this run counter to the very principle of COBRA, which is the guaranteed right of consumers, once they pay up, to continue the same coverage? But I am being denied that coverage if my wife cannot "guest" on another network.

: : Your thoughts and experience about this matter would be very welcome.

: : Thanks

: :
: : /Fin

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Subject: Re: Re: Re: Forced to be "Out of Network"

Comments:
: Fin : Your COBRA benefits should be the same as your group health insurance benefits, so there should be no exemption for COBRA. It sounds like they really want to make an exemption for an expensive pregnancy. : You will need to contact a department of labor investigator to resolve this. : Craig : : Sorry: my EMail below is incorrect: it should be "fjk4@columbia.edu"not "fjk4@columbia.edi" /Fin : : : My wife and I discovered shortly after moving to Nevada from New York that she was pregnant. Since we have access to COBRA and, now, a "pre-existing condition" (the pregnancy) no local insurer will touch us. So, we are forced to use COBRA. : : : However, since my former employer in New York pays for a NY-NJ-Connecticut Network POS plan we are deemed "out of network" every time we incur medical costs. : : : There is a provision in the POS plan paid for by my employer that allows for "guesting" of family members on networks elsewhere in the country e.g. the Nevada network. : : : However the insurance company refuses to allow my wife to guest on their Nevada network because we are on COBRA. As a result we stand to incur several thousand dollars worth of out-of-network (coinsurance and deductible) expenses when my wife has her scheduled C-section in August. This is on top of the $1000 per month we are paying the insurance company through COBRA. : : : My question in this: apart from any humanitarian or common-sense considerations (which I know are immaterial to the corporate parties in these situations--I merely mention them because we happen to be human beings not money-trees) surely we are being discriminated against by virtue of the fact that we pay through COBRA? : : : If so, does not this run counter to the very principle of COBRA, which is the guaranteed right of consumers, once they pay up, to continue the same coverage? But I am being denied that coverage if my wife cannot "guest" on another network. : : : Your thoughts and experience about this matter would be very welcome. : : : Thanks : : : : : : /Fin

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