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Insurance Woes
updated: Jan 25, 2013, 8:10 PM

By Edhat Subscriber

Dear Edhat readers, my wife's company, a large employer in Santa Barbara County, just changed her employment status from "part time" which qualified her for health insurance benefits, to "on call" effectively eliminating her from qualifying any longer for the company sponsored health insurance. They have given her only 6 days notice. This is very distressing since we are both on this insurance plan and have been given very little time to figure out what our options will be. Are any readers familiar with the laws here in California regarding company sponsored insurance? Can anyone suggest a good lawyer to discuss our concerns with?

Comments in order of when they were received | (reverse order)

COMMENT 367555P	2013-01-25 08:20 PM
The federal law says you can continue the insurance but of course y'all will have to pay for it. There is no need for an attorney. Don't waste your money. Google "COBRA".
COMMENT 367557	2013-01-25 08:31 PM
Don't pay attention to the advice tendered by 555. First, most attorneys who specialize in this area will provide you with a free, initial consultation. Second, most work on a contingency fee basis, meaning you don't pay an hourly fee. Thirdly, if there is a discriminatory or illegal reason for the reduction in hours, then it could be grounds for a lawsuit. You would probably need an attorney to determine whether such grounds exist. 555 is correct that under the COBRA laws, an employee is entitled to continue health insurance coverage at the employee's expense. It must be paid for, however, at the group (business) rate and can be a substantial savings over some individual policies. The business is required by law to provide written notice of COBRA eligibility.
COMMENT 367558	2013-01-25 08:31 PM
I hate to say it but be grateful you had it for so long. I've opened a savings account for only emergency health issues. It's better than giving some corporation my hard earned money every month and having them feed me a story of why they won't pay when I'm in need. Look after yourself on your own terms. Others are no longer in it for the greater good. It's sad but true.
COMMENT 367563P	2013-01-25 08:43 PM
557 got it right in general, and I'm advising in general: Sign up and pay for COBRA insurance IMMEDIATELY if you intend to continue or obtain any coverage. Either consult an employment or insurance atty. or start shopping. signed -- currently uninsured.
COMMENT 367565P	2013-01-25 08:45 PM
Previous poster here -- Sorry to be so unhelpful. I do have a local atty. I would ask for references. If I do so I will post them.
COMMENT 367569P	2013-01-25 09:03 PM
Do some online research before contacting a lawyer. You may be eligible for COBRA -- there's California COBRA and a federal version. Some info is available here. http://www.hmohelp.ca.gov/ In the upper right hand search box, type COBRA. Your company's human resources department should have information, also.
COMMENT 367576	2013-01-25 10:36 PM
That is a REAL bummer, sorry for you and the stress you must be going through. COBRA is your best bet. Do not be surprised by what happened though. Health insurance is enormously expensive for companies to provide; it's a common tactic to change employee status to eliminate the obligation to cover it. In addition to the advice above, and since you are obviously not able to describe all the details here, I suggest keeping a log of all facts, dates, and a file with copies of everything in case you do take action. You are undoubtedly upset at the moment, but keeping track of everything will be of great value, however this goes. Also, gather info on whether this has happened to other people if you end up wanting to prove discrimination. Otherwise, hang on for health reform when we all will have better, more affordable options.
COMMENT 367579	2013-01-25 10:47 PM
Honestly, take your chances. I was fired from a job in 2001 and since have been without insurance. Live well, hope for the best, and if you have a serious problem go to the local Westside or Eastside clinics.
COMMENT 367583P	2013-01-25 11:17 PM
So 'on call' is the new euphemism for 'You Fired' then?
BECKY	2013-01-25 11:31 PM
Cobra is expensive, but perhaps less so than other options. Long term, we all need single payer, because tying insurance to your job is insane. It's just a relic of WWII, and it's past time to move to everyone's insured, and all policies are individual policies. Then, if we can return to the idea of "spread the risk" -- which is what insurance was initially designed to do -- and get rid of "for profit" from insurance... Wow! We might return to improving and paying for health, rather than debating how to enrich yet another legalized betting scam, where the house always decides who wins and loses.
COMMENT 367589P	2013-01-26 01:28 AM
Right on Becky. For profit insurance companies have one agenda - make a profit for their shareholders. Nothing wrong with that for a for profit company. But - the way health insurance companies make a profit is to take in in premiums more than they pay out in benefits. Refusing to cover anyone who they think might need the insurance and to cover anything expensive is the way they do that. This country definitely needs a one payer health insurance program with everyone insured.
COMMENT 367598P	2013-01-26 06:50 AM
596 is correct; however, I doubt many will notice or accept the connection. Employers cutting hours and changing status to avoid coverage expenses is a natural result stemming from the ACA (Obamacare) I know this because my company recently had a closed door session to determine how to deal with the bankrupting costs associated with the new healthcare laws and that is exactly how we are dealing with it. The OP might even be an employee of ours. There is no free lunch, folks, everything has a cost. You can't vote for free or subsidized stuff without it costing someone somewhere something. Nature's laws, not mine.
COMMENT 367614	2013-01-26 07:43 AM
596 got it Right !!!
COMMENT 367618	2013-01-26 07:53 AM
A part-timer had health benefits??? That's pretty unusual, isn't it? I'm afraid you can be layed off with barely any warning. 2 weeks notice? Fugetaboudit. You can also leave without giving notice - quit on the spot - without any legal repercussions. At least those were the contractual requirements I had to agree to in my last place of employment at a non-profit agency. As you can see opinions differ and the ones with a political agenda differ more than most.
COMMENT 367620	2013-01-26 07:55 AM
You were getting insurance for your wife and you on a part time job? I would say that alone is extremely rare (even with full time jobs)
COMMENT 367630	2013-01-26 08:20 AM
The fact of the matter is that this has been happening for a long time. It is just worse now with PPACA as the cost to employers has jumped significantly. Simply put, now an employer must continue to keep children to age 26. That is up to 8 additional years than was previously the case. That alone is a huge difference in cost. But the main reason for this article is the fact that older employees cost more and generally have families to be covered= cost more and younger employees cost less. It is not rocket science folks. I have no agenda that supports the left or the right. I'm a health insurance agent that has seen this for long time. 3.5 Billion in net profit( 1 carrier operating in 14 states) for a quarter? It certainly isn't the carriers who are getting the squeeze.
COMMENT 367639	2013-01-26 08:28 AM
DAN39- that works until one gets hit by a car or cancer.
COMMENT 367641	2013-01-26 08:36 AM
Lawyers? Geez people, its a job not a right... This is a result of the Affordable Care Act - AKA ObamaCare. The costs have increased greatly for companies and many are cutting down status of eligible employees to reduce their exposure (capitalism). I'd say that you're lucky you had it at all at a part-time status. Find a new job (where's your insurance) or buy your own. I have to buy my own as do many, many people. But a lawyer? You'll get nothing but bills and headaches from an attorney in this type of case.
COMMENT 367651	2013-01-26 08:48 AM
The reduction in hours to avoid paying insurance is nothing new. Decades ago I had to staff using only a couple of full time employees and the rest had to work no more than 18 hours a week so they would not be eligible for health benefits. As one of the many with no health insurance, I would love to be able to go to the doctor, but can not afford unless it is desperate. My employers however have fabulous plans for which I am the one doing the work to pay for...it is the American way.
COMMENT 367653	2013-01-26 08:49 AM
The ACA is proving to be a disaster for everyone. They sold the public this albatross by mixing up health care and health insurance in the same discussion. Health insurance does not guarantee anything in terms of health care. Costs for health care will not come down until the profit is removed from the system and the players charge less for their services. ACA is a ponzi scheme designed to take what's left of the middle class wealth and hand it over to insurance corps. I think every single person should cancel their insurance right now, and watch how fast the game changes. Let's get these criminals out of our health care system for good. What kind of people allow profit to be a major factor in health services? Sickos and cheap merchants willing to make a buck off your illness. A lot of bucks in fact all of your bucks if you get really ill. Follow Dans advice and go to the SB Clinics, and put the huge premium bucks in the bank, not their bank, yours.
COMMENT 367656	2013-01-26 09:01 AM
651 - anyone who positions themselves in this manner is a poor business person... did you cancel your car insurance, your fire insurance, your GL insurance too? How about your cable and cell phones? You're either a horrifically bad manager or a liar... which one is it?
COMMENT 367661	2013-01-26 09:14 AM
Great reading! It amazes me how some people can get this far in life, yet remain so completely clueless (@643).
COMMENT 367674	2013-01-26 09:40 AM
Although I don't necessarily agree with the sentiment of 653, I agree that this country has a huge problem with the practice of combining health INSURANCE with health CARE. The terms have become one and the same- and yet the products are vastly different. Health insurance should be like placing a bet with the insurance company that you will remain healthy. If not, they pay for your care. Health care should be when you need to go and get a flu shot, or a medical exam, or get a broken bone splinted. Why should these two things be tied together, any more than say auto insurance and auto mechanics? Are we gone too far down the road with the "health care" industry to ever start again? BTW I have been uninsured ever since I was laid off 3 yrs ago- to stay on my employer's plan would have cost me $600 a month which is most of what I was getting on unemployment. I am in my 40's and healthy (knock on wood).
COMMENT 367677	2013-01-26 09:47 AM
We can expect many adjustments in health care as people try to live with ACA. My physician just sent out a letter that he will no longer deal with medicare.
COMMENT 367683	2013-01-26 09:53 AM
656, 651 here I think you misread my post I do not know of any reputable business that expects its employees to pay the business car, fire or GL insurance (or their telephone and cable service) for them. The maximum hours for the front line staff (the people customers work with) was set at the corporate level (by fully insured & full time staff) for the company I worked for back in the 80-90's. (Different company long out of business due to foolish back office vps) And it is because I am a good manager that the current business owners I work for can afford good health insurance (along with the other insurances) I would love to have employer supported health care as well. I do not. And that is the American Way.
COMMENT 367685	2013-01-26 09:56 AM
Tell your wife to go get a full time job with benefits. EZPZ lemon squeezy.
COMMENT 367690	2013-01-26 10:07 AM
to 684 You are correct. An employer doesnt have to cover families/children, but the fact of the matter is many have and still do. It takes benefits/pay to keep good employees. Taking benefits away, hurts the business by potentially losing good employyees to other employers. Keeping the benefits in place hurts the businesses bottom line due to the extra costs of an additional possible 8 years of dependents on the plan. More importantly though is the fact that older people cost more and younger peole cost less to a business. Until this changes, nothing will change in this dynamic.
COMMENT 367695P	2013-01-26 10:20 AM
COBRA is a joke. when the company i was working for liquidated in 2007 i was offered the "opportunity" to continue the healthcare that i had been paying about $120/month for through my employer. the cost was around $1100, when i asked if that was quarterly or annual i was informed that would be the monthly rate! $1100 a month for health coverage! that was more than half of my monthly take home pay from the job i had just been laid off from. mind you i was 25 years old and a single man with no prior health conditions. fortunately i had just finished my major prerequisites at city college and transferred into UCSB full time that fall, gaining university coverage for my tenure. even now, with a decent paying full time job with benefits my health insurance has some scary gaps in coverage.
COMMENT 367713P	2013-01-26 11:14 AM
695, your insurance was part of a group policy. The business subsidized your insurance. When you got laid off COBRA offered you the opportunity to purchase the same insurance as you had at your job but the business owner(s) were no longer subsidizing your insurance. Why is it so hard to understand? Now that Obamacare is kicking in and requiring insurance companies to cover everyone including the so called "womens health issues" and adults on their parents policy, the insurance carriers are naturally having to adjust their rates upwards. As a business owner something has to give. We either have to reduce the number of employees we cover or charge a non-competitive price for our products to cover the mandated insurance. If we charge a non-competitive price for our products we will not be able to stay in business. Then all of our employees will be unemployed.
SECCO	2013-01-26 11:27 AM
I am a physician who's practice income is currently based 95% upon payments from insurance companies and Medicare. Also a good portion of my services are rendered, without compensation, to the uninsured. Also, I am currently paying $1300 per month via COBRA for insurance for me, my wife and child. Every single day I have to haggle with insurance companies to get them to agree to cover the services my patients paid to have covered. The insurance companies use every possible means and tactic to avoid utilization and payment. If they aren't simply denying coverage for care that is necessary and appropriate, they will use other means to discourage utilization. For example, requiring the doctor to go through a 30+ minute telephonic "preauthorization" process before a routine med prescription is approved (which in many cases is denied anyway without realistic opportunity for appeal). Or ridiculously high copays for certain services. I am glad the ACA is coming. It will not solve many of the current problems, but it will make a difference for many, and it will be a start towards reigning in the abuses of the insurance industry. But, between now and the official "start" in 2014, we can expect to see lots of the kind of thing the OP described, which will put lots of people in that kind of bind. Yes, there is COBRA, but it's usually unfairly priced. I believe a single-payer system would be the best, but it ain't gonna happen here in the US, with it's pro-business, lobbied-to-death legislatures. The best we can do is continue to demand more regulation of the insurance industry, via strengthening of the ACA.
COMMENT 367764P	2013-01-26 01:45 PM
Thank you, Secco, for your comments from your perspective as a physician. Thank you, also, for the care you give without jumping ship off the medical system. Thank you for appreciating the need for ACA. Seems at some point it will all get settled out, and help from people like you will go a long way to making it happen!
COMMENT 367777P	2013-01-26 02:50 PM
@695 states that at age 25, presumably in good health, to continue his Medical Insurance under COBRA would have cost him $1,100.00 per month. How can anyone not be shocked with disbelief at this kind of outrageous pricing. Exactly WHAT about medical services needed by 25 year old men, could justify that kind of premium? That is the level of premium I would expect to be paying were I a 50 year old tobacco smoker.
COMMENT 367815P	2013-01-26 04:21 PM
@777 hmm, let's see - a broken leg snowboarding requiring surgery? Appendectomy? The price seems high but is this for an hmo or ppo? What is the deductible? What is the co-pay?
COMMENT 367819P	2013-01-26 04:25 PM
thank you 777, (though i'm not sure why my last comment was deleted) it was outrageous. i ended up purchasing a short term coverage package during the time between my layoff and attending UCSB and guess what? i needed no medical services whatsoever. i'm 30 now and have full coverage under employment again. i've used my medical insurance once in the last 3 years to have an infection from surfing drained. it still cost me over $400 out of pocket to get a quick scalpel job that didn't even need stitches. i firmly believe that the for-profit model of health care will inevitably fail; sort of like our de-regulated banking system, the war in iraq and the domestic war on victimless crime (aka illegal drugs).
COMMENT 367878P	2013-01-26 07:04 PM
Wishful thinking, 693. 670P, the fact that people voted against the right wing agenda and in favor of a liberal agenda doesn't make Obama himself a liberal. Republican-lite, at best. Trying to bail us out? Are you kidding? He's offered to give up SSI and Medicare! At this point he owns Obamacare, the m-i complex's "war," and other various plans afoot to drain the US treasury into corporate bank accounts.
CORKY	2013-01-26 08:43 PM
Yes for single payer.

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