If a health insurer has your last name completely wrong, are you actually covered?

My wife just discovered that although I was added to her work insurance 14 months ago at a cost of nearly $400 a month, they had assumed that my last name was the same as hers, and have had the policy as my first name and her last name all this time. So we are correcting it; but now I’m wondering if the thousands of dollars we paid in premiums over that time was wasted and if I should ask for a refund. I never have used it at all, so it just was never tested.

If I had been in a car accident or something, would they have honored the policy with a completely different last name? I know there would have been a problem at first for sure, but would they have eventually paid my medical bills (minus deductible obv.) or not?

They did apparently have my Social Security number, which is how it finally got flagged.

  1. I am not 100% certain you would have had no problems, but I think you would have been covered fine
  2. The chances of you recovering any previously paid premiums are basically 0%. :slight_smile:

Good post, Clark. The thing that really bugs me is that I don’t think the percentages of number one and two match up–or more accurately, are purely reciprocal to each other. Which really irks me, because of course I could never prove that. Unless there is some sort of clear evidence that insurers do deny claims in these kinds of circumstances.

My understanding is if all parties acted in good faith – no intent to deceive on your part, no intent to deny coverage on their part – then typos and minor misunderstandings would not be a problem.

The reverse happens to women who get married all the time. You most likely were tracked by something other than (or in addition to) your name, as name changes are common. Might have had a hiccup when you tried to get treatment but the insurance company would have straightened that out pretty quickly had an issue come up.

You don’t have a chance of getting money back from the insurance company. You were covered and cannot prove a loss.

Too late to edit but I wanted to add:

A reasonable person could see that you meant to have coverage and they meant to cover you. The assumption of the last name, while a bit careless, is quite understandable. I think it’s a safe bet that you were covered – and if it ever got as far as court I’m confident that would be the ruling – and thus you got what you paid for.

Missed where they had you SSN#. You were covered. No loss of service can be shown. Don’t bother asking for a refund unless you like being laughed at or scolded for trying.

I’ve known people who had a name error on insurance before, and it was basically just a paperwork annoyance to get it sorted out, it wasn’t anything like ‘no coverage is available’, it was 'we need to fix this before we actually cut you a check.

But was it a completely different last name or just a misspelling?

I’ve worked in health insurance for close to 15 years, I concur with the following points

  1. Had something happened the paperwork SNAFU would have eventually been sorted out and the claim paid.
  2. Since you paid for and actually had coverage asking for money back is going to be both ineffective and annoy your HR rep.

Interesting question. My friend had an issue for awhile with her daughter’s insurance. They had her birthday wrong and no matter how often she tried to have it changed, the change never happened. It worked out ok, but there were never any large claims. They have different insurance now, not possible for the OP since it’s through his wife’s employer. I do agree that if all parties are acting in good faith there shouldn’t be an issue. I’d also get it changed as soon as possible. I do have to ask though, didn’t your wife have to complete paperwork to put you on the policy or did HR just handle everything?

Presumably you are identified to the insurance company by something more than name only - “Relationship” (spouse) and SSN? Birth date? etc.

if so, then correcting one data point is going to be trivial and as others point out, not an impediment to claims. I doubt any insurance company allows random people to be simply added to a policy, enumerated only by a name “John Smith” and no other details; then wait until a claim comes along to fill in the details. “John Smith…? Yes, that’s… um … me.”

I thought she filled out some kind of paperwork but she certainly didn’t give me her last name. So HR must’ve done the final paperwork. I’m guessing they took my last name to be a middle name.

“Legal name” is a fuzzy concept, largely for exactly this reason. On the one hand, you cannot evade responsibility simply by saying “That’s not my legal name” but the other side of the coin is that your identity cannot be denied simply by pointing out the same discrepancy.

When you got listed on the insurance policy under that name, you in fact “went by that name” with no intent to defraud, which is the legal test for any name you claim to be legal.

Don/t worry about it, but notify the insurer and have new documents mailed to you.

Courts will generally reform a contract to reflect the parties’ intentions so long as that intent is clear. The plan administrator would have denied coverage to SlackerInc Wifesname, because that person was not identified as a beneficiary and is not in the category of individuals eligible for spousal coverage. So the insurer’s intent to not cover that person is clear. SlackerInc Actualname clearly is in that category, and the parties’ intent to cover you is also clear.

Having said that, your wife is likely at fault here; beneficiary designation forms always require the enrollee to provide names and SSNs, and she must have provided them with the latter.

She did provide my SSN; as I mentioned in the OP, they did have that. But if you’re saying she must have written down my first name with her last name, there is 0.0% chance of it. I’d bet the house on that.

No, I’m saying she must have failed to write down your name on the beneficiary designation form at all.

Possible. Or they interpreted my last name as a middle name (it actually is probably more common as a middle name than my actual middle name is). ETA: I think the real problem is that we live in a place where a woman having a different last name than her husband, even a professional teacher with two master’s degrees, is utterly beyond most people’s comprehension. It doesn’t even hit their radar screen to think it might be the case; and then when they are forced to confront it, they are baffled. Feels like a real time warp.

I don’t understand what you mean here.

The plan administrator to me clearly intended to cover Wifesname’s spouse, who is in the category eligible for spousal coverage, and somebody (wife? HR? plan admin?) misidentified Wifesname’s spouse as SlackerInc Wifesname instead of SlackerInc ActualName. How is the insurer’s intent to not cover SlackerInc Wifesname thereby clear?

I’m guessing from SlackerInc’s description that he thinks his wife put down on the form SlackerInc ActualName and the HR department interpreted this as SlackerInc A. Wifesname, which is the sort of silly mistake harried clerks sometimes make, so intent to not cover seems an even harder case to make.

I found the post you’re referring to a little confusing, but after rereading it I think it’s not actually in disagreement with you or the rest of the thread on the main points.