Slammed

I do have a copy of the benefits, not just the summary. It's 104 pages and from I've read, there's what I believe applies to my situation. I wished I can get a copy of the contract specific of the plan itself...to understand how the stop loss or the Aggregate coverage. Refund of Benefit Payments If the Claim Administrator pays benefits for Eligible Expenses incurred by you or your Dependents and it is found that the payment was more than it should have been, or was made in error, the Plan has the right to a refund from the person to or for whom such benefits were paid, any other insurance company, or any other organization. If no refund is received, the Claim Administrator may deduct any refund due it from any future benefit payment. Subrogation If the Plan pays or provides benefits for you or your Dependents, the Plan is subrogated to all rights of recovery which you or your Dependent have in contract, tort, or otherwise against any person, organization, or insurer for the amount of benefits the Plan has paid or provided. That means the Plan may use your rights to recover money through judgment, settlement, or otherwise from any person, organization, or insurer. For the purposes of this provision, subrogation means the substitution of one person or entity (the Plan) in the place of another (you or your Dependent) with reference to a lawful claim, demand or right, so that he or she who is substituted succeeds to the rights of the other in relation to the debt or claim, and its rights or remedies. Right of Reimbursement In jurisdictions where subrogation rights are not recognized, or where subrogation rights are precluded by factual circumstances, the Plan will have a right of reimbursement. If you or your Dependent recover money from any person, organization, or insurer for an injury or condition for which the Plan paid benefits, you or your Dependent agree to reimburse the Plan from the recovered money for the amount of benefits paid or provided by the Plan. That means you or your Dependent will pay to the Plan the amount of money recovered by you through judgment, settlement or otherwise from the third party or their insurer, as well as from any person, organization or insurer, up to the amount of benefits paid or provided by the Plan. Right to Recovery by Subrogation or Reimbursement You or your Dependent agree to promptly furnish to the Plan all information which you have concerning your rights of recovery from any person, organization, or insurer and to fully assist and cooperate with the Plan in protecting and obtaining its reimbursement and subrogation rights. You, your Dependent or your attorney will notify the Plan before settling any claim or suit so as to enable us to enforce our rights by participating in the settlement of the claim or suit. You or your Dependent further agree not to allow the reimbursement and subrogation rights of the Plan to be limited or harmed by any acts or failure to act on your part.

Well, at the beginning, the company wasn't planning to file bankruptcy. However, weeks later, creditors sued them into involuntary Ch 7. So, the company filed Ch 11 to stop the Ch 7. It's very messy. Employees already signed up for Cobra and used it for almost 2 months now.

No one will give me the plan details...I just wanted to read to see if there's a stop loss run out period. I'm pretty sure if I were to get this information, I would need help to decipher it. From what I've heard so far, there's several employees now that are finding out that their claims unpaid. With my situation, the claims HAVE been paid, but posted to the account. Just don't know what will happen later down the road. I've been told by a BCBS rep not to worry, because now it's between the employer and BCBS (which I STRONGLY hope). And until I get a written notice from the providers or BCBS, I can only assume it's ok...I just called the providers today and confirmed again the payments and everything looks ok. This is an unusual situation and I am thankful for all of your insights.

Yes, I have contacted the DOL and they said that they already have several cases currently opened for this company. From my understanding, their claims have NOT been paid yet. Or they had signed up for Cobra only to find out the company is not paying their premiums on that too!

I did call the provider, they have posted the payment, and they don't see anything wrong. However, they are appealing the claim since they are want for more money. I found out just now that more employees are in similar boat...however, in their situations, their claims are not being paid at all. I don't understand how a company is allow to do this and from what I've been advised there's no much the DOL can do.

We need some insight...my husband had a major medical emergency earlier this year. He was fully covered at the time. I have found out that his company's health plan is self funded and BCBS is the administrator. Fast forward to several months later, his company abruptly closed, now filling Ch 11. His claims are high-dollar, about 900k and it took BCBS a while to finalized the claims due to the complexity of the claim. BCBS send payment over to the hospital, which they confirmed to me that the payment has posted. However, now, we are being told by his HR that they never funded the account for BCBS to issue payment and the HR is confused on how a payment was made. The BCBS reps told me that they would never send over payment if there were insufficient funds in the account and when they issued the payment, there was sufficient funds in the employer's account. So, my question is, can BCBS ask for that payment back from the hospital and then we will be liable that bill even though he was insured during the time of hospitalization? BTW...the EOB (which I saved) says we owe $0. Or what how do you think this will play out? We are worried sick. Thank you.