A year ago my Cobra insurance was ending. I thought it ended on Jan 10th, and so ordered on Jan 9th, but it actually ended December 31st. I ordered a 3 month refill of a prescription via Caremark. Caremark requested a $70 co-pay and filled it. It seems to me that Caremark and Aetna had a hand-shake agreement between them, or should have had one such that I should have been notified that my cost was not $70 but instead would be $620, whereupon I would have cancelled.
It's not a hard stretch of imagination to wonder if Caremark conveniently didn't check coverage. The medication was not critical and I would have cancelled and done without it.
Have I a legal leg to stand on?
You can probably settle w AETNA for much much less than they're asking. Alternatively they would have to sue you. Hard case to prove. ERISA, Federal Court. Not a lot of carriers would spend $10-25k to recover $550.
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