Expecting Couple Fights Surprise Coverage Cancelation

By Consumers For Quality Care, on June 12, 2019

Expecting Couple Fights Surprise Coverage Cancelation

Caitlin and Corey Gaffer were shocked when they opened their mail, last October, to a notice saying the insurance they had been covered by for two years had been canceled, Kaiser Health News reports. The couple was in the middle of their first pregnancy. The couple thought they had paid their premium, as they did every month. But the paper staring back at them said they hadn’t. Caitlin was in disbelief.

The letter from their insurer, HealthPartners, said their coverage had been canceled mid-September and was dated October 8. In early September, the Gaffers had changed checking accounts. It turned out, when they changed the automatic payment for their $730 monthly premium, they mistakenly sent it to a hospital owned by HealthPartners, not the insurer. The hospital failed to inform the plan that they had mistakenly received the premium. When the Gaffers made their October payment, to the correct place, they had insufficient funds to cover the amount.

“It was a busy time in our life,” said Corey, 32, who runs an architectural photography studio. “We made these two little mistakes, but were never given any notice that we were making mistakes until after the fact.” 

While the ACA included provisions to try and protect consumers from having their plans canceled, they did not cover all cancelations. The statutes that are in place to protect consumers differ from state to state.

Like the Gaffers, tens of thousands of Americans each year — exact counts aren’t available — are dropped by their insurers over payment issues, sometimes with little or no prior warning from their insurers.

Because the Gaffers did not qualify for an ACA subsidy, they were subject to state law. In Minnesota, where they live, the law requires insurers to give at least 30-days notice before canceling a plan. Experts say this 30-day grace period is the law in most states.

The Gaffers fought their insurer over the cancelation of their policy. Although all consumers, not just those with subsidies, were supposed to receive 30-day notice, appeals documents revealed that HealthPartners did not send letters notifying them of past-due payments, unless they received subsidies.

The insurer says they have changed their policy since the Gaffers’ case. HealthPartners now notifies consumers of missing payments on the 15th of the month.

The Gaffers remained uninsured for a time as they fought HealthPartners. In this time, the couple accumulated $30,000 in medical bills related to the pregnancy. Luckily, they received new insurance before their daughter was born in January.

After KHN began looking into the Gaffer’s case, HealthPartners contacted the couple saying they wanted to reinstate their policy and cover the outstanding medical bills.

“We’ve apologized to the family, reinstated their coverage and view this situation as an opportunity where we can do better,” spokeswoman Johnson said in an email.

The Gaffers say they have learned a lot from the experience. Mainly, Corey says, is the importance of advocating for yourself. The couple is happy HealthPartners has updated their policy to help others, too.

Oh, and just to be sure, the couple’s premiums are now on “auto pay” and “we have like eight calendar reminders set up,” Caitlin said. “Today it popped up three times: ‘Make sure insurance is paid.’”