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Learn more about Caffrey Insurance Solutions, Inc.
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Ask Lynn |
This is a forum for information-sharing. If you have a story from which others might benefit, please forward along with your questions.
If your employer tells you that you can't join the company health plan until open enrollment, he or she may be wrong.
There are other times you can join. One of them is upon loss of other coverage, such as coverage through a spouse who lost employment. Another is upon the end of Cobra. A third is upon change in status, such as marriage, childbirth or divorce.
All enrollments need to be made within 31 days and are effective the next first of the month after the event leading to lost coverage. Childbirth is an exception where coverage comes at birth.
For loss of coverage, you will be sent a Certificate of Creditable Coverage which you will need to present to the new carrier. Don't wait for it to make application; it won't come in for a few weeks after your coverage ends. |
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I was floating down the Russian River when a friend called to tell me that I had been named Best Health Insurance Broker in the East Bay Express Best of the Bay awards.
The review said that I was "an extremely dedicated full service health-insurance broker... Caffrey apparently never sleeps." The truth is that I often exchange emails late at night with clients, and sometimes the back and forth gets ridiculous enough that I pick up the phone and we talk, often at midnight!
I admit it--I am tenacious about finding the best possible plans for my clients. I talk to many people these days who have lost their jobs, which means they have lost their health insurance and are faced with paying the monthly premiums themselves. In addition to expensive premiums, they are faced with high deductibles at a time when they have very little discretionary money. It is my commitment to do whatever I can to help them keep their families insured. |
Caffrey at Work: Example of Insurance Quandary
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 One of my clients purchased a plan called a Basic PPO. This was very basic coverage that was fine until she fell off a ladder and broke her pelvis and wrist.
Under this plan, doctors are not paid until the out-of-pocket maximum ($3500) is met. Five months later, they have not paid the hospital bill and are now asking for records again. In the meantime, they've declined all her doctors bills that would have been paid at 100% had the hospital been paid before those bills came in.
I didn't think this mattered, because claims, in my experience, are processed based on when they are incurred. This plan, however, pays based on when the insurer processes the claim. Once declined, the insurer won't go back. It means at least $10,000 to my client who cannot pay the claims or seek the further treatment she needs. What's next: I will appeal the claims as far as I can which includes up to the insurance commissioner. I believe the carrier sat on the claim unnecessarily which served to avoid paying the doctors, but I may not be able to prove it.
My clients should know that having a broker advocate can be very effective. In the past I have saved clients $100,000+ in reprocessed claims that they wouldn't have known to or been able to achieve on their own.
The lesson is to really understand the ramifications of an inexpensive health insurance plan. |
| What's Going On: A Costly Mistake | |
 One of my clients was late paying her monthly Cobra premium and received a notice that her coverage had been cancelled. Her efforts at reinstatement fell on deaf ears.
When insurance companies identify a payment date, it is imperative that they receive payment by that date or your insurance will be terminated. In the case of this client, she was not able to find a new plan that compared to the Cobra. Her new policy has a huge deductible which won't begin to pay for a year's worth of routine office visits and lab work. |
| About Lynn |
| Lynn Caffrey and Caffrey Insurance Solutions is an employee benefits brokerage firm that provides insurance expertise for small companies (fewer than 50 employees) and individuals seeking Individual coverage.
Caffrey Insurance works with you to find the best insurance benefits that provide the best value, tailored to the unique needs of your company.
California License Information Individual: 0557451
Corporate: OG80281
336 Lenox Avenue, Oakland, CA, 94610
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