Nevada family reportedly faces $1.2M in medical bills over ObamaCare typo, confusion

[ErikJ]

Source: Fox News

A Nevada family reportedly is grappling with more than $1 million in medical bills, after the insurance they bought on the ObamaCare exchange refused to pay claims over a typo and other issues.

The Las Vegas Review-Journal reports that Kynell and Amber Smith are dealing with a six-month nightmare. It all started when Amber Smith in February delivered her daughter five weeks early.

Her 40-day hospital stay reportedly included two surgeries.

But the Review-Journal reports that the Anthem Blue Cross insurance they got through the Nevada Health Link -- an ObamaCare exchange -- is not paying claims. The payments are being denied, reportedly because the mother's birth year is incorrectly listed on the insurance card. It should be 1979, but is listed as 1978.

The newspaper reports the family is also struggling to get their baby daughter Kinsley added to the insurance. They are facing $1.2 million in medical bills.
.....................................

Read more: http://www.foxnews.com/politics/2014/08/08/nevada-family-faces-12m-in-medical-bills-over-obamacare-typo-confusion/

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The Cons are hitting the ACA hard with this one. But ironically it shows how much we still need a non-profit Single-payer health care system.

[randys1]

1. this is WHY we MUST get RID of INSURANCE COMPANIES

that fox is reporting this

GOD DAMMIT

FOX AND THEIR VIEWERS LOVE IT WHEN A CORP CAN SCREW PEOPLE BUT I BET NOT THIS TIME, RIGHT!!!


This infuriates me on two levels

a. the insurance must not be allowed to do this, and I am pretty sure they wont, especially since she is YOUNGER not OLDER

b. that FOX reports this to bad mouth ACA, FOX and the LEMMINGS that watch LOVE it when corps can stick it to people, as long as they are not the people

just god damn infuriating

[yeoman6987]

27. Ok. I agree with you on almost all of your points except

what are the employees of the insurance companies supposed to do? That will make unemployment up to 10 percent at least. I know that the big bad insurance companies are horrible, but the workers are not.

[Xipe Totec]

37. That's Bad argument Number Three; Appeal to Consequences

http://almossawi.com/bookofbadarguments.html

[MsLeopard]

42. A lot of them can move into the jobs

that will be created by more services when everyone is covered. There will be all kinds of jobs opening up from the production of more supplies needed to the actual care givers. At least that's how I see it. We need single payer now.

[gateley]

2. Did the woman submit her birth year incorrectly, or did the insurance company

do the typo?

Same old insurance company bullshit.

I hope she gets this resolved.

[elleng]

3. They shouldn't have to scream about this but

having made the 'news,' it likely will be resolved. (imo.) Of course it has little to do with 'Obamacare,' insurance companies make mistakes all the time.

[Spitfire of ATJ]

4. I was in a clinic a while back and there was a notice to employees to not accept Blue Cross....

They used to be member owned and nonprofit and that's when they gained the reputation of being the best. Then they went corporate and got listed on the Stock Exchange and followed the model of all other big insurance companies. That model being the people pay you their premiums and you refuse to pay for even basic care.

[frylock]

5. this never happened prior to ACA

ever

[cheapdate]

7. Things were great befotre the ACA.

[elleng]

20. :Sarcasm: I assume.

Insurers have made errors, clerical and otherwise, since the beginning. Same as any other business.

[airplaneman]

6. It seems to me the insurance companies are looking for ways to get out of paying.

As they did before the ACA they are again finding ways of not paying.
I have become aware of two ways they are doing this to me.
Facility fees - Besides the co-pay I am being charged a separate not-covered fee called a facility fee at the clinic I went to for a procedure. The only other option is to have the procedure done at a hospital for a much larger co-pay and here again the insurance company has now declared a baseline on the clinic charge so I would have to personally pay the difference if I go where they charge more. My choice is pay more, pay a lot more, or don't have the procedure.
-Airplane

[hedda_foil]

8. Oh good grief! She has a lot better chance of this getting paid with the ACA than not.

Like, she's in Nevada. It seems to me that one of her Senators is Harry Reid. A call to his office would get the insurance company to pay up pretty darn fast.

[salib]

9. This is an excellent example of why ObamaCare (ACA) is a huge improvement

Imagine the news if this were not ObamaCare:

(-crickets-)

Exactly. The only way to have any chance against the insurance companies is to bring the only truly large protector into the picture:

The Government

[elleng]

21. YES.

THANKS.

[Sunlei]

10. Blue Cross always tries hard not pay claims any way they can! We need non-profit healthcare!!

Blue Cross would not even cover people until they got their claws into the 'free' Federal money gravy train!!

[jwirr]

16. I agree. Not to long ago we needed a new piece for my daughters wheelchair. It cost $22. They

said no because she did not have a wheelchair. They would not listen to the doctor, the social worker or the pharmacy. They did listen to me: I told them that they had paid for the wheelchair in the 80s and if they did not give us the part we needed we would apply for a brand new chair. We had the part in 2 weeks.

I tell this because I agree that they try any thing they can to get out of paying.

[cynzke]

33. Decades ago....

My sister was hospitalized and very ill. She had to be transferred to a larger hospital to have emergency surgery to save her life. Afterwards, the insurance company didn't want to pay certain bills because one of the doctors performing the surgery was not in network and my sister didn't get prior approval. She told the insurance company "how the hell was she suppose to get prior approval when she was unconscious, requiring emergency surgery to save her life"? The insurance company got back to her later, telling my sister they decided THIS ONE TIME, to make an EXCEPTION and pay the bill. LOL....who were they kidding?

[jwirr]

41. In these cases you need to talk back. Somewhere there is a worker who is not getting it and has

been told to reduce costs. Often times with medical issues we do not talk back and once they get by with it once they do it again and again.

These are the cases that show us why we still need single payer.

[cynzke]

35. Don't remember the name, but...

There use to be a website on the net about BC/BS complaints, where you could post your experience as well as read other people's horror stories.

[1StrongBlackMan]

11. How is this an "ObamaCare" issue ...

Isn't that an (all to typical) Anthem Blue Cross issue?

And further, won't the Ombudsman part built into the ACA eventually resolve the problem?

[DRoseDARs]

15. Because it's NOT an Obamacare issue. It's Fox being Fox, lying per usual.

This was an issue with the Nevada Health Exchange and Anthem BlueCross & BlueShield.

[1StrongBlackMan]

18. It's not even a Nevada Health Exchange issue. eom.

[DRoseDARs]

22. My mistake, thank you. I'm Nevadan, so I'm aware our exchange had serious problems...

...so I jumped the gun and made an assumption. Xerox lost its contract with the state this past May over the issues.

[PersonNumber503602]

12. What a disgusting company.

What kind of pieces of human garbage can actually sleep at night after doing that?

[klyon]

14. insurance companies deny almost every claim at least once

you have to spend hours on the phone talking to person after person until they decide to pay
they hope you give up
single payer is the only way to go
hospitals also need to go back to nonprofit

[Unknown Beatle]

13. 1.2 Million Dollars

for a forty day stay at the hospital? WTF? How much is the actual cost and how much is for profit. I realize that they need a profit to stay in business, but 1.2 million for forty days is ridiculous.

[4b5f940728b232b034e4]

26. And that's the real problem!

People keep talking about details on who provides coverage and other details that are not significant compared to $1,200,000 for two surgeries! When a simple problem can cost more than someone makes in a lifetime, single-payer or not will not fix the issue.

[christx30]

28. This is the same industry

that brought us the $3000 ultrasound and the $40 aspirin. And why it's illegal to buy drugs overseas where it's 1/10th of what drug companies charge here. We have much to be thankful for.

[Fortinbras Armstrong]

38. Earlier this year, I got a piece of glass embedded in my foot

I went to the hospital ER to have it taken out, and I also had a tetanus shot. On the bill, the shot came to $163. I asked my doctor some time later how much he would charge for a tetanus shot, and he said $40.

[Corey_Baker08]

17. I Am Confident This Issue Will Be Resolved & Their Insurance Company Will Pay Up...

As far as them 'fighting to get their newborn on their insurance', this should be absolutely no problem. Under the Affordable Care Act anyone under the age of 27 can stay on their parents insurance, which is obvious from the article that the parent(s) do in fact already have health insurance through the ACA through Anthem Blue Cross Blue Shield....

I am hoping that Anthem Blue Cross corrects the mistake because its only logical that the mistake was made by the insurance company because it seems absolutely absurd to think that the woman in question forget the year of her birth, I would say that it comes down to a simple typo on behalf of the individual at Anthem Blue Cross or the Nevada Health Exchange worker who helped sign her up for the insurance policy.

Either way I hope this gets resolved peacefully & quickly because if they haven't already the Conservatives will be jumping all over this. However I believe it also shows that Obamacare is working, just think if the Affordable Health-care Act was non-existent, this woman would probably have had absolutely NO insurance. Imagine having NO insurance and going through this catastrophic health situation, having to pay 1.2 million dollars just to save the life of your baby because of complications during birth, not to mention the cost of the Doctors saving her & her babies lives at the same time requiring multiple surgeries and a 40 day hospital stay in most likely the intensive care unit, now without insurance I do not even want to begin to imagine the effect this would take on the family not only financially but emotionally.

I am 25 years old and thanks to President Obama, I have health & dental insurance because of the Affordable Health Act. I saw a woman wearing a shirt that said 'Repeal Obamacare', so I walked up to the lady and politely told her that I currently have insurance because of the Affordable Care Act, I then asked her if she ever actually read the bill...Her reply was no, so as someone who has read the bill I started informing her of things that would benefit her that is now in effect because of the ACA. She was an older woman, probably 59 or 60, and I asked her if she knew that her insurance company can no longer deny her due to pre-existing conditions, I reminded her that there are so many things that her insurance will now cover such as mammograms & other preventive health-care options thanks to President Obama and as she called it, 'Obamacare'.

I was surprised she seemed to have actually been listening, she was polite and I saw her facial impressions change as I told her some of the benefits of the ACA that benefit women. She seemed taken back and was virtually speechless but at the end, she shook my hand and introduced herself to me.

It was an experience that reminded me that with facts, statistics and a friendly conversation, perhaps we can inform some voters who know nothing about the ACA but choose to dislike it because her husband doesn't like it because of the Bullshit spewed out by Republicans & Fox News, so this year, 2014, we need a great voter turnout that are going to vote for Democrats, even if they don't happen to be Democrats or have no party affiliation at all, we need the young to show up in mass, and we need independent voters who have saw the Republicans block everything & shut down OUR government...

[Dustlawyer]

19. Of course they did the same stuff before! When my second son was born early with

unknown complications and the bill started climbing, they tried to avoid paying by saying we had never called to add him to the policy. I called my agent and the home office from the delivery room. My agent called the home office and recorded it. They backed down until the doctors figured out what was wrong with my son, he had Cystic Fibrosis. The insurance company knew they would pay out a lot over his lifetime, so a week after we had learned the terrible news they canceled again saying we had committed fraud in the application (we had not)!
After getting an attorney specializing in EURISA (sp), a Federal statute governing most insurance plans and he found a possible loophole, they backed down again. The problem is that insurance companies can commit Bad Faith under this statute, but the most you can recover is making them pay per the policy and pay your attorneys fees. No punitive damages, nothing to dissuade them from making the attempt at not covering an expensive claim. This is why they pull this shit on people when the people need them most!

[cynzke]

36. I suspect...

that insurance companies try to delay adding newborns to a policy because there may be unknown health issues that don't manifest at time of birth. Then if the baby does have a medical problem, the insurance company tries to wiggle out of coverage claiming that the insureds didn't add the baby in time for coverage. People are always reporting difficulty in getting a new born added to an existing policy.

[Strelnikov_]

23. Sounds like we need to amend ACA to include Medicare for all

so this never happens again.

[McCamy Taylor]

24. Blue Cross was a member of ALEC and lobbied hard against the ACA all the way to the end.

BCBS should never have been permitted to participate in the exchanges., I suspect that they are attempting to sabotage the ACA. They know that they will have to pay. But by delaying payment right now they create problems in advance of the 2014 elections. The same for their bait and switch game in California, the one for which they are being sued.

[valerief]

25. You can't change a leopard's spots. Insurance cos do what insurance cos do. nt

[quadrature]

29. how much is the co-pay?

what plan do they have, silver, gold?
is their hospital in the network?

without some details,
I find these stories hard to believe

[drm604]

30. This will be resolved.

From the article:

The exchange reportedly is trying to solve the Smith family's problem "as quickly as possible."

Of course this is the next to the last sentence, while the huge blaring headline states that the family faces over a million in medical bills. This is typical Fox reporting. Put the spin in huge type near the top, then put the facts at the bottom of the page.

In any case, it's not like insurance errors haven't always occurred. I recently went through a nightmare that was totally the fault of Blue Cross (which I have through my employer) and it had zero to do with the ACA.

I needed an expensive medication (thousands of dollars). I was told by Blue Cross to use a specific specialty mail order pharmacy. I used the pharmacy they told me to use, got the medicine, and then received a statement indicating that I had used an out of network pharmacy and therefore was responsible for the full amount myself.

When I called to dispute it, the rep told me it was because I had used an out of state pharmacy and that there was nothing they could do. Fortunately my employer's plan includes access to a health advocacy company that handles these things and they got it straightened out and billed correctly (I had done the right thing and BC was in error).

I say all of this as an example that things sometimes go wrong in life and mistakes are made. The idea that one mistake indicates that the ACA is a total failure is just silly.

[6000eliot]

31. Why is this the fault of the ACA?

[MADem]

34. Annnnnd.....you'll get CRICKETS in response to that question, too!!!

This isn't about the ACA--it's about a wrong data entry causing a kerfluffle.

[hughee99]

43. About the only way I can see how this is even remotely related to the ACA

is that people who didn't used to have health insurance now do, so they ALSO have to deal with the same insurer bullshit that everyone with insurance has been dealing with for decades.

[area51]

32. Single. Payer. Now.

Everyone raise their hand who didn't see this coming. Leaving the serial killer for-profit insurance cos. in charge of our access to health care was going to lead to things like this.

[davidpdx]

40. I agree we need single payer or universal

In South Korea we have universal coverage and it has worked great.

[Vinca]

39. The problem is a typo, not Obamacare.

When I was in the pre-existing condition pool I had a colonoscopy done and the insurance company - Obamacare PCIP - refused to pay. After investigation, I found the doctor had incorrectly entered the information for the hospital coding and the coding ended up being different from what the procedure was. It took months to straighten it out, but they eventually paid. Her birth year was obviously entered incorrectly at some point and for a million dollars in bills, I'd already have an attorney on the case.

[Mz Pip]

44. The insurance company is at fault

Not the ACA. The insurance company is looking for a reason not to pay. It's found a technicality in the incorrect birthday.