If you’ve been reading my blog for awhile, you might remember the medical issues that my daughter faced last summer (I wrote about it here, here, here, and here). She survived and all is well. But, as you can read about here, even though her medical problems resolved, my fight with the insurance company had just begun.
Here’s what I haven’t told you. The bastards lovely people at Regence Blue Cross/Blue Shield not only dropped my children and ex-husband (he was the carrier of the insurance… I had a separate plan for myself), they retro-actively canceled the policy. Meaning that “it is as if the policy with Regence Blue Cross/Blue Shield never existed”.
So, my kids were insurance-less. AND Regence was going to not only NOT cover any of the tens of thousands of dollars for all of Emma’s surgeries and medical care, they were also going to go back to every doctor, lab, hospital, etc that they HAD paid on my children’s behalf and get their money back.
It took approximately 50 phone calls and mountains of paperwork, but we were lucky that between Primary Children’s Hospital “forgiving” the outstanding balance as well as Medicaid stepping in cover the rest, I was only out of pocket a fraction of what was owed. Even though financially I survived, I seriously wanted justice. Revenge. BLOOD! OK, maybe not blood, but I was pissed.
I didn’t understand how an insurance company could just “dump” an entire family after we’d paid every premium. They claimed Emma’s medical history wasn’t fully or correctly disclosed when my ex applied for coverage. Regence pointed to a few specific questions on the application such as, “Has any member of the family suffered from any back, head, or neck injuries”, and “Does anyone have any deformities”. OK, this was a slightly enlarged lymph node on Emma’s neck that you couldn’t even see. I just happened to feel it one day. A pediatric ENT told us it was nothing and to not worry about it, and that’s just what we did. I would not consider this a deformity OR a neck, back or head injury. So 6 months after her first visit to the doctor in 2007 (the one where we were told the lump was within a normal range) neither my ex nor I even thought about her little lump. If a doctor tells you that you have a cold and it’s not cancer and you’ll be fine, do you remember it when you’re applying for medical coverage? Even if you remembered, would it be something you’d even note? NO! It wasn’t until 5 months after coverage began when the lymph node started growing and the problems began.
After paying thousands of dollars in insurance premiums, having my children dropped by their insurance company made me feel cheated, taken, and also incredibly helpless. How was I going to take on a multi-BILLION dollar HMO? I had already gone through their wonderful (and oh so fair) appeals process and it got me nowhere. Then again, how could I do nothing? And the bigger problem and question for me was what was I going to do now that my children had NO coverage? The thought of wrapping them in bubble wrap did cross my mind but unfortunately I thought hat might get in the way of, oh, you know, thier lives! Luckily Uncle Sam jumped in and CHIP covered the kiddies seeing as they were “uninsurable”. It’s nice when you actually see your tax dollars come back to you a little. ANYWAY…
After many tears of frustration and sleepless nights, I decided to look for a lawyer to see what, if any, options I had.
I found a lawyer (who the day before had just won a case against the same insurance company) that was willing to take our case and would only take a fee based on what, if anything, we won. I figured I had nothing to lose. If I lost, I was out nothing (except damaged pride) and if I won, SWEET! It was more of a statement that I was trying to make. I didn’t care or expect to see dime, but felt like it was my responsibility to let Regence know that I would NOT lay down and let them get away with this without a fight.
When I first sat down with the lawyers and showed them the paperwork Regence had sent explaining why they were canceling the policy, they all started to smile and laugh in that “wft” and “this is unbelievable” kind of way. Brad, one of the associate lawyers, said “Seriously, they are so dead. This is absolute crap and they know it”. I think that was his way of telling me that we had a good case.
All of this took place last summer and early fall. Fast forward to today. After months and months of back and forth negotiations, Regence has offered a settlement to which the we have agreed to. After the lawyers and Medicaid are paid, there will be a small amount of $ left over (nothing to get excited about). It will be enough to pay off all of the medical bills that I had to pay as well as the $4000+ my ex had to shell out of his own pocket for medical bills while he went without coverage for over 8 months.
Even though Regence settled and in a small way I feel like I won, I’m still disgusted that they did this and that retroactively canceling peoples policies is common place for all HMOs. It’s all about risk-analysis and $, and I find it nothing less than criminal that a company who deals with people’s health… their LIVES… is willing to take a chance and cancel a families policy to try to save a few bucks.
This settlement won’t even put a dent in Regence’s pocket and I have a feeling that they will continue to roll the dice and bet that the majority of people they “dump” (because of some trumped up bullshit reason) will do nothing.
While I don’t have an answer for the health care crisis in America, I do know that what is happening now is NOT WORKING! HMO executives have multi-million salaries (plus rediculous other perks) while Joe Shmoe is taking in the arse. I, for one, think it’s pure evil that there are people getting disgustingly rich at the literal expense of the people they “service”.
(Stepping off of the soap box).
This is the second time in the last year and a half in which I can say the justice system has worked for me. It may be flawed but sometimes Goliath falls and David walks away victorious.
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