PA Woman Faces $16K Bill After Fainting

By Consumers For Quality Care, on March 6, 2019

A Pennsylvania woman received a medical bill of more than $16,000 after her short-term limited-duration insurance plan failed to cover her fully, Lancaster Online reports. Pennsylvania Insurance Commissioner Jessica Altman highlighted the consumer’s story at a recent U.S. House subcommittee hearing.

The woman who fainted hit her head, Altman said, and the plan paid $200 toward the cost of the ambulance ride, with maximum benefits of $250 for the emergency room, $1,250 for the intensive care unit and $1,250 for an outpatient test.

“After considering cost-sharing, to include the payable benefits being applied to the consumer’s deductible and coinsurance,” Altman said, the plan “covered just over $1,300 and the consumer was stuck with a bill of over $16,000.”

Altman is a vocal opponent of short-term limited-duration insurance plans, which fool people into believing they have coverage. Pennsylvania’s department of insurance received 23 complaints about the plans in 2018.

Altman highlighted two other consumers who had issues with the plans. One man had a payment request for a heart condition denied by his plan on the basis of a pre-existing condition, although he had never sought or received care for his condition before.

Another woman’s insurer demanded 3 years of medical claims to determine if a hospitalization for a virus was linked to a pre-existing condition, according to Altman.

“Claims payments totaling over $42,000 were finally made on the consumer’s behalf only after the involvement of our department.”