I was recently contacted by a client who was denied coverage under her husband’s health insurance plan. The reason for the denial was that her claim was for a service that occurred after the judge had signed her divorce but before she knew it had been signed.
First, some background. Most companies will allow an employee to continue to cover his or her spouse under a family health insurance plan after a legal separation but before a divorce. The reason for this is that a spouse is still considered a family member until the divorce.
In this instance, the wife was being covered by her husband’s employer under a family plan and sought medical care. When she did so, she provided her husband’s insurance card and obtained the service. Shortly after that, I received the divorce papers back from the judge who had signed them a few days before the medical service.
As is my practice, when I received the signed divorce papers I entered them in the county clerk’s office and provided each of my clients with a certified copy of the judgment of divorce.
The husband then notified his employer that he was now divorced and the insurance company removed her as a covered person. They then denied her claim for the medical service based on the date the divorce was signed, even though it was not filed until after the medical service.
I believe that the insurance company was incorrect in denying coverage. In New York, a divorce is final when the judgment is signed by the judge, and the judgment is entered in the records of the County Clerk.
It is the entry in the county clerk’s office that completes the divorce process. Until it is entered, the divorce is not final.
In this instance, my client was faced with the prospect of either initiating legal action to compel the insurance company to pay the claim or just pay it herself. Since the claim was only for an office visit, it made more sense for her to pay it.
But, if it had been a substantial medical claim, such as a hospital stay or surgical procedure, I suspect it would have been worth her while to initiate legal action to compel the insurance company to pay the claim.
Has anyone else encountered this situation? If so, how was it resolved?