By Consumers for Quality Care, on May 30, 2018
Amanda Schornhorst wasn’t too alarmed when she felt a lump in her breast. Six years prior, she had been diagnosed with cysts, WTHR reports. She expected a mammogram to show the same thing this time around.
When Schornhorst went to the doctor for a routine check-up a few months later, she was not surprised when he ordered tests to rule out anything more serious. Unfortunately, the tests confirmed Stage 2 breast cancer instead.
“It’s aggressive and it has spread to a few of the lymph nodes, so the recommendation was chemotherapy right away,” Schornhorst explained. “This disease is terrible. We know there’s a lot of survivors, and I’m going to be one. But I was scared and I’m scared every day.”
Schornhorst and her doctors wanted to start treatment immediately. Her insurer, United Healthcare, put a stop to that, saying they would not pay any medical bills until they reviewed her medical records further.
“My chemotherapy was put on hold because they say my cancer was a pre-existing condition. It makes me so mad. This is the same insurance company I’ve had for over five years. They would have known if I had breast cancer.”
After two weeks, Schorhorst’s oncologist Brian Mulherin determined that she could not wait any longer for treatment. He feared any longer delay would advance the disease to a point that it may no longer be curable.
Schornhorst moved forward with treatments, quickly accumulating over $200,000 in medical bills.
While Schornhorst had health insurance, it was a short-term health plan – CQC has previously highlighted the risks associated with these types of plans and voiced our opposition to a proposed rule that would expand them further.
Schornhorst had been purchasing short-term health care plans every 3 months for the past several years. The plan was inexpensive, saving the Schornhorsts as much as $10,000 a year.
“For us, we felt that was the only option to do the short-term plan,” said Schornhorst, who is a stay-at-home mom. “We are very healthy and we don’t go to the doctor very often, so it seemed to make sense.”
Schornhorst learned first hand that these short-term plans can carry risks for consumers.
“People need to know if you have a pre-existing condition, it’s not going to be covered under a short-term policy, and you’re not going to have coverage for any ongoing conditions,” said Tony Nefouse, owner of Nefouse & Associates Insurance in Indianapolis. “So many families will look at the savings and go with a savings versus a permanent policy, but if they’re going into it blindly and not reading the policy and the exclusions, it can be a bad thing.”
Mark Howard, an Indianapolis insurance broker, says that short-term plans leave consumers like Schornhorst “up a creek without a paddle.”
“The insurance company has denied every claim we have submitted from the very beginning,” she said, flipping through a large stack of denial notices from United Healthcare. “They even denied paying for the initial mammogram. The financial detriment that I’m doing to our family, do I stop treatment and let the cancer win? The internal struggle that I have because of the amount of bills that come, it’s too hard. It’s not fair.”