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Insurance Carrier Helps Woman Who ‘Fell between the Cracks’

One of my clients went through an exciting merger with another company. But in the flurry of closing activities, there was confusion on the formal transition date. As a result, my client inadvertently ended its health plan 15 days before the merged company’s new plan kicked in.

So the employees were temporarily without health insurance—they “fell between the cracks.”

This turned out to be a critical issue when one woman needed urgent medical care. She had to see a doctor right away for a condition that could get much worse if left untreated. 

But if she went to the doctor without insurance, it would cost her hundreds of dollars. Maybe even thousands, depending on what testing and prescriptions were needed.

The instant I learned of the situation, I called my primary contact at the insurance carrier. I explained the situation, emphasizing that the employee needed to see her doctor the next morning to treat her illness, and that she was afraid of not being able afford the care.

My contact quickly grasped the gravity of the problem, and told me she would make this case her priority. But I was anxious. The carrier’s standard turn-around time for customer service issues is 4-7 business days. And even in “urgent” situations, they can take up to 48 hours to respond.

I was prepared to escalate the situation to the carrier’s senior management. But incredibly, my contact came through in less than an hour. She was able to reinstate my client’s insurance, and said the woman would be covered for her doctor’s appointment and whatever follow-up care she needed.

A week later, true to that promise, the employee had seen her doctor, gotten the treatment she needed (with only the usual co-pays), and was back at work, healthy. My client was very appreciative, both for the personal attention I gave to the problem and the carrier’s unexpectedly rapid (and compassionate) response.

That just goes to show you, insurance companies CAN come through sometimes for the benefit of people in urgent need of medical care.