One of my kids wasn't added to our "family" dental plan...not sure what to do??

[LoveBWVVBR]

**UPDATE** As of yesterday the dental ins. was made retroactive to her birth. I have no idea what actually transpired, but once the agent got her into the system DH's boss was able to call the company and get it made retroactive. The agent was the problem, period. I'm glad that it worked out in our favor, but what a hassle for us, DH's boss, etc. all because of an incompetent agent

We've had a family dental plan through DH's work for years. When we had child #2 2 years ago, we immediately had her added to our benefits. Well, she just had her first dental cleaning in Aug. at the same time as our 4.5 y.o.'s cleaning. Our 4.5 y.o. was covered, but our 2 y.o. wasn't. Apparently they don't have a record of her being on the dental benefits (the insurance company, that is).

DH and his boss are both furious at the insurance agent/company, saying that we pay for a family plan and that our youngest should be covered as she is part of the family. The insurance agent has been useless I guess. She claims that our youngest was never added to the plan, and of course we have no proof that she was because the agent would have been the one to add her The insurance company has added her but will only cover her back to Oct. 1st Her appt. was in Aug. I had no reason to think that she wasn't on our insurance at that time...I mean, she was added to all of our other benefits in a timely fashion. I have no idea what to do. Is there a way to force the issue with the insurance company? I don't want to get stuck paying a $75 bill when we already pay to have family dental coverage

 

[msmayor]

Probably not much you can do, because you don't have written proof that she was added.

I assume this insurance is through your DH's work? I'd suggest that every year, during open enrollment, you carefully check coverages and ensure that everything is correct. This is really the only time during the year when its possible to make these changes (unless you experience a "life event").

Document, document, document.

 

[Bren's Mom]

Isn't there a form dh must fill add to add someone to benefits? Did he fill out this form when the 2nd child was born? If so, then did he or his boss keep a copy?

 

[3boymthr]

See if your husband's company has the enrollment form from when your DD was born and/or from his last open enrollment. The department that handles benefits should have it. I say should but unfortunately sometimes these things get lost. If they don't have it and you don't have a copy of it then there is nothing you can do. The enrollment form needs to spell out your daughter's name if it doesn't then there is nothing you can do. There are provisions in place in 99.99% of contracts that state the insurers only have to go back 90 days in the event of a new hire or other "life event" for both additions and terminations. If your husband's employer does have it then the insurance company is obligated to cover her back to the time the enrollment form was filled out.

 

[Monte Cristo]

After open enrollment at my company, I receive a confirmation of benefits sheet in the mail with one last opportunity to make changes if there are errors or omissions. It doens't sound like your husband's company does this...or could you guys have missed it?

 

[LoveBWVVBR]

After open enrollment at my company, I receive a confirmation of benefits sheet in the mail with one last opportunity to make changes if there are errors or omissions. It doens't sound like your husband's company does this...or could you guys have missed it?

They don't do this. They are a really small company (only 11 employees I think?), and they have an outside insurance agent that handles all of the benefits-related stuff. I'm beyond PO'd that this agent never added my child. We did fill out everything that we needed to fill out 2 years ago. She was apparently added to everything but the dental insurance

 

[Nik's Mom]

That stinks. I'd be mad too. I cannot believe that they don't give you some type of confirmation as to who is covered. How else are you supposed to know if everything is accurate? I would make sure that you get something in writing for next year. I hope thsi gets resolved for you, since it wasn't your fault.

 

[StephMK]

They don't do this. They are a really small company (only 11 employees I think?), and they have an outside insurance agent that handles all of the benefits-related stuff. I'm beyond PO'd that this agent never added my child. We did fill out everything that we needed to fill out 2 years ago. She was apparently added to everything but the dental insurance

So I assume they probably use a small local agency for their insurance? Did the request get sent in writing or a phone call? I would have DH or his boss talk to the agency again. I would think if they argue that the child was added to your other benefits, she should have been included on the dental.

If the CSR won't budge (probably doesn't want to get in trouble), talk to the producer (sales guy) on the account. I do not think a producer or mgr will want to risk the possiblity of losing an account over a $75 bill. Ask them to pay the $75 as goodwill, I would think if this is a smaller agency, they will pay it to keep their client happy if there is a good relationship established.

 

[dismom24]

This happened to us and we uout while we were sitting at the eye Dr office waiting to be seen. They saw her twin, but refused to see her unless I paid or had the ins thing taken care of. We had the ins company on the phone and it was fixed within minutes. If she was added to all the others, it is obviously their mistake.

 

[LoveBWVVBR]

That stinks. I'd be mad too. I cannot believe that they don't give you some type of confirmation as to who is covered. How else are you supposed to know if everything is accurate? I would make sure that you get something in writing for next year. I hope thsi gets resolved for you, since it wasn't your fault.

We get a card every year from The Principal stating that the dental benefits are "DH's name + family". I never thought to question that the "family" didn't include my 2 y.o. After all, they had no problem adding my older child when she was born

 

[LoveBWVVBR]

So I assume they probably use a small local agency for their insurance? Did the request get sent in writing or a phone call? I would have DH or his boss talk to the agency again. I would think if they argue that the child was added to your other benefits, she should have been included on the dental.

If the CSR won't budge (probably doesn't want to get in trouble), talk to the producer (sales guy) on the account. I do not think a producer or mgr will want to risk the possiblity of losing an account over a $75 bill. Ask them to pay the $75 as goodwill, I would think if this is a smaller agency, they will pay it to keep their client happy if there is a good relationship established.

Yes, I'm pretty sure that it's a small local agency. They are blaming DH's boss for not sending in the paperwork, but yet DH's boss managed to add my DD to everything else so I'm not buying that it was his fault at all. DH did say that the agent was dumb as a rock and a waste of time. I didn't think of asking for her boss. I'll try that if I call them directly.

 

[StephMK]

Yes, I'm pretty sure that it's a small local agency. They are blaming DH's boss for not sending in the paperwork, but yet DH's boss managed to add my DD to everything else so I'm not buying that it was his fault at all. DH did say that the agent was dumb as a rock and a waste of time. I didn't think of asking for her boss. I'll try that if I call them directly.

Depending on exactly how small the office is, the girl you have been dealing with is probably the service person, CSR. She stays in the office & handles the paperwork, renewals, etc. There should be an agent who originally sold the account (might be the owner) and he/she is the one dependent on keeping the account to keep getting paid. Sometimes their name is on the policy under the agency information.

Unless she handles the sales and service for her own accounts (unlikely), there is someone above her who is dependent on the commission from your DH's office account with them. That is the person you need to talk to because they have a vested interest in keeping you happy.

 

[Mom2Ben02]

I have a newborn, and called to add him to insurance the day after he was born. I work for a very large company, so we have an HR dept that handles it. The person who answered actually giggled when I double checked that he was added to the dental and vision ins. She thought I would not need it, since he does not have teeth. I told her that you never know what could happen, so to please add him...

Maybe your agent had the same thinking, and assumed that you'd add the child later?

Sorry - that STINKS.

 

[beaucoup]

Unless you have documentation of your request in writing or email, its your word against theirs.

Also, when ever you request ANY changes, you receive written documentation back that it has been put into place. When you didn't receive that, you should have followed up to make sure she was covered.

I have a place in my bill folder of everything in life that is pending. I would have a note there reminding me I haven't received acknowledgement of the change from insurance company yet. Then I would have followed up on it.

Running a home & life is just like running a business. Checks and balances. Accountability. Follow ups and documentation.

 

[Nik's Mom]

We get a card every year from The Principal stating that the dental benefits are "DH's name + family". I never thought to question that the "family" didn't include my 2 y.o. After all, they had no problem adding my older child when she was born

Yeah, I can totally see your point. I would ask for proof that everyone is included next year, since they have proven that they can make a mistake when registering everyone for insurance.

 

[Fierce Fairy]

This has happened to my family as well. It was with my 16 year old that was just dropped for no reason. My husband has worked for the same large company for the pass 11 years...so she has been covered since she was 5. I believe some INS co's drop as a business decision to save money. I worked as a volunteer that assisted seniors in navigating the ins. paperwork. You can contact your states agency that grants INS co's the right to do business. They have a complaint department. A rep there can help if you must go that route. Good luck.

 

[bdoyledimou]

I had a an issue where my divorce decree indicated that my ex spouse was to be on my group health benefits for 5 years. During those 5 years i became common law (which is recognized by my insurance) with another woman. When i tried to add her to my insurance, the company dropped my ex.. breaching the court order.

Hell fires rained from the sky for a few weeks while that mess was sorted out..

they ended up making ex wife a child/dependant on my insurance for the last two years..

 

[cm8]

Yeah, I can totally see your point. I would ask for proof that everyone is included next year, since they have proven that they can make a mistake when registering everyone for insurance.

 

[sam_gordon]

We get insurance cards for all of us (myself, DW, & all three kids). Did you get a card for your 2yo? Does it indicate Dental?

 

[sam_gordon]

BTW, I think you are at least partially responsible since it's been two years and you haven't noticed the discrepency.