Reply #7: I'll go you one better [View All]

[DefenseLawyer]

I was a principle owner of a law firm for about 10 years. I had a group insurance plan that covered me and my family as well as my partners and employees and their families. At the end of last year we closed the office and liquidated the corporation. Because the group plan was not longer operative, I made arrangements to get an individual plan for me and my family (at no small expense) with the same company, Anthem, through the same agent. We had a "maternity rider" on the old plan, however when the agent submitted the new plan he left the rider off. I caught the mistake immediately and he said it was no problem and he contacted them the next day and it was added before the policy was written and before the new policy went into effect. Well as it turns out, we found out my wife was pregnant with our 3rd like a week later. We went through everything normally. Doctor visits, hospital etc etc. Everything went through our insurance, no one ever said there was a problem. In fact at the hospital the business office lady stopped in to tell us that our bill had been processed and we had met our deductible etc etc. This was last month. In the last week we have gotten bills from the OB and the hospital saying that we weren't covered because this was a "new" policy and there is a 9 month waiting period for the maternity rider to kick in on "new" policies. So about 12 grand staring me in the face. Now believe me, I have not yet begun to fight, but essentially it appears the insurance company is using the fact that the agent forgot to add the rider and it had to be "added" a day later and being a break from the old policy and therefore they refuse to cover during the waiting period. Never mind that I have paid a couple hundred a month extra for the maternity rider for the last 10 years. As they say, stay tuned.