A Las Vegas family has been slammed with nearly $1.2 million in medical bills due to an Obamacare exchange issue.
In October, Kynell and Amber Smith bought insurance from Anthem Blue Cross through Nevada Health Link, their state’s exchange. They made two premium payments in January. Initially, their monthly premium was set at $1,575. Nevada Health Link contacted the Smiths in March to notify them that they were overpaying and needed a new policy. That reduced their premium to $1,296.
Great news, right?
Well, no.
In fact, for the last six months, it’s been nothing but a struggle for the family.
The trouble began after the birth of the family’s fifth child back in February. Their daughter Kinsley was born five weeks early, and the infant had to spend 10 days in the hospital. Amber’s hospital stay was 40 days, and included two surgeries.
All of their insurance claims are being denied.
The reason?
Amber’s birth year is incorrect on the insurance cards. It’s one year off – it’s written as 1978, but should be 1979.
The Smiths also can’t get Kinsley added to their plan, despite placing “dozens of calls” to Nevada Health Link and Anthem. This means the family is responsible for all of the baby’s follow-up care.
Since the switch, Kynell said he can no longer see policy details or billing information online, but they haven’t missed a payment.
“All I know is, I am sending checks and they are cashing them,” Smith said.
In addition, some of Amber’s specialists are no longer participating in their provider’s networks, leaving the Smiths with additional unexpected expenses.
Kynell told Las Vegas Review-Journal he’s tried to get the issues resolved, and is being billed by providers:
“I have spent countless hours on the phone trying to get this resolved. I have contacted and pleaded with elected officials to help and was told I may have to sue to get this resolved. What kind of answer is that?
“They (providers) keep threatening to send me to collections,” Smith said. “I’m like, ‘OK. Would you like me to make $25 payments on 12 doctors, plus all of our hospital bills? I can’t pay all of you.’”
The Smiths aren’t the only ones who have experienced serious issues with the Nevada exchange. Larry Basich was hit with $407,000 in medical bills after the exchange and it’s contractor – Xerox – sent his payments to the wrong insurer. His ordeal was finally resolved in March.
In May, Nevada Health Link dropped Xerox and its system because of the rampant technical issues.
Las Vegas Review-Journal reports that the exchange and Anthem are aware of the issues and are working to fix them:
Spokesman CJ Bawden said the exchange is “fully aware” of the Smiths’ case.
“We’re working very quickly to solve it,” he said. “There are multiple issues incorporated in this case, and it’s something that just takes a bit of time to work through. But we’re trying to solve it as quickly as possible so they will have access to their health insurance, and will be able to go back and make sure charges accrued over this time period are taken care of by their insurance.”
Anthem spokeswoman Joyzelle Davis said the case “illustrates the frustrations we and the health exchange have had in dealing with Xerox.”
Xerox built its software so that changes such as birth dates have to be handled by the exchange system rather than by the carrier, Davis said.
Xerox also told Anthem the only way to add a baby to a family policy is to cancel the policy for the entire household and reissue a plan with the newborn on it.
Davis said Anthem’s records show Xerox cancelled the Smiths’ old policy but hasn’t yet applied payments and coverage to a new plan. Anthem has “repeatedly escalated” the issue to Xerox in recent weeks, Davis said, and company officials were “hopeful” that the issue would be fixed by the end of the day Thursday. If that doesn’t happen, Anthem will explore “alternative approaches,” Davis said.
Kynell said Nevada Health Link transferred him to a “special case unit” in April, but the representative can’t tell him when the issues will be resolved.
RJ reports that the Smiths have contacted a law firm about the issue, and are shopping for new insurance – this time, though a local broker.
“I’m just praying for January to get here so I can get out of the exchange as quickly as possible,” Kynell said.
Obviously still a lot of work to be done! Both my sons were premature and wife suffered with the HELP syndrome in both cases so there was a much time for all three in the hospitals e the further cost of a paediatrician for the babies.the cost to us, zero! We did pay our 110 dollars per month health insurance premium though.