“Life is what happens to you while you’re busy making plans.” – John Lennon
Life comes at you fast sometimes. My husband and I were planning for retirement a few years down the road. We were planning on taking long vacations with our grandson, and spending time together at last. With each of his birthdays, as I added another candle to the cake, I would mention how many years until we could walk away from this life they call railroading, at the magical age of 60. My husband was only months from reaching 30 years of service when he was hospitalized. Many tests and two stays in the hospital later, we found ourselves sitting in the office of an oncologist. The doctor told him he had worked his last day on the railroad, and was to retire and enjoy the time we have left. We thought the only thing we had to worry about was getting him well enough to live with gusto every minute he had left.
Wrong! About two months from the time he went off sick, we received a letter from the health insurance company. It informed us of our right to pick up the COBRA option. Also, the letter said if he was disabled they would be giving us coverage for this rest of this year and for two calendar years following. This letter also stated that they needed a statement from the doctor indicating the reason for the disability. We called the insurance company and asked if there was a form, or if they needed a letter from the doctor, since there was no form included in their letter. The woman he spoke to said they don’t usually send out the form until the employee had been off for four months, but she would send it to us so we could have the doctor fill it out. They would keep it on file for the future. We felt we had fulfilled all the requirements of the insurance company, and were taken care of.
About a month later, my husband had to go to a special dentist because of his condition. The dentist informed us that we were not covered by insurance. We were shocked. After all, hadn’t we done all the right things? I called the insurance company again, and couldn’t get through to their representative what I was talking about. She said, according to the form submitted by the doctor, that my husband was able to return to work on the 31st of the previous month. I had a copy of the form in my hand and read it to her. The doctor had written in the space for the date to return to work “Unknown due to current illness.” She said there was nothing she could do, and we were not insured. Panic set in because the next day he was scheduled for chemotherapy, and I didn’t want to think about how much that would cost. I went the Vice-General Chairman of my husband’s committee. I was so upset, I don’t know how he understood me, but I guess he did because he said, “This happens all the time. I will take care of it.” His words made me feel a little better, but then began to ring in my head. “IT HAPPENS ALL THE TIME?!” That meant I was not alone in this problem, which is good right? Wrong, it means there are a lot of people out there going through the same thing. I needed to know more about this situation so others wouldn’t have the same trauma that we experienced.
What I learned is that after one calendar month of not performing work for a minimum of seven days in that month, an employee’s name is dropped from the list of those eligible for insurance. The insurance coverage is automatically cancelled. The Vice-General Chairman made the call to the Carrier, and made sure that his name was listed as sick. Apparently this doesn’t happen automatically.
We received a second insurance form for proof of disability in the mail. I took it to the doctor’s office, but the office staff that fills these forms out all the time had trouble interpreting it. They did the best they could and faxed it to the insurance company. Well, guess what? We were dropped again on the date the doctor signed and dated the form. The insurance company took that as the date to return to work. The doctor’s staff was just as baffled as we were. Why does this insurance company make the form so ambiguous?
The most annoying part of this whole ordeal is that the insurance company does not inform you that you are dropped and no longer have insurance coverage. You find out when you try to get a prescription or go to the hospital. They just drop your coverage.
When I called the insurance company for the third time, I finally spoke to someone who could tell me what the problem was. As it turns out, they require a date of some sort in the space where it says, “date to return to work.” The doctor must put in a date, or if permanently disabled, the wording must be “Never to return to work,” or “permanently disabled.” If you do not fit either of those categories, the doctor must indicate some kind of date, like the end of the current calendar year. You can always return to work prior than that but if the doctor is not sure when you will be able to return, it is best to put the end of the current calendar year.
There is a flaw in the communication between the employee and the insurance company. We were lucky because we understood that the contract stated that we were entitled to health insurance for two calendar years after the employee went off sick, and the spouse is entitled to health insurance for one calendar year. If we had not been aware of that, we probably would bought the COBRA coverage out of fear, paying for coverage that was already guaranteed. In talking to others with similar problems, I have found that this is not the only scenario. If you are injured on the job, whether or not you have filed a lawsuit, there are more problems. All I can address is what my experience has been. When I hear that phrase, “It happens all the time,” it sends off signals that something is wrong with the system and it needs to be fixed. If the person who handles the insurance coverage in a doctor’s office can not interpret the form, then the form needs to be changed. This ordeal has caused our family a lot of unnecessary anxiety. You have enough to worry about when faced with serious health issues without the added anxiety of worrying about whether you are covered by health insurance on a minute to minute basis. This is cruel and unusual treatment.