By Consumers For Quality Care, on April 9, 2019
In 2016, Charley Butler was diagnosed with testicular cancer and he believed that his health insurance would help cover the cost of his care. Butler had previously been contacted by a broker for National Brokers of America Inc. and signed up for an 11-month insurance plan, Los Angeles Times reports. Butler said that the plan seemed straightforward and, at $146 a month, was a far cheaper option than the other plans offered on the ACA marketplace.
His insurance card, which he received from Health Insurance Innovations, identified his coverage as a “Premier” plan that offered services through a “MultiPlan Complementary Network,” which appeared to be the plan’s network of physicians and hospitals.
In the six months following Butler’s cancer diagnosis, which had spread to his lungs, he underwent two surgeries and chemotherapy. He told Los Angeles Times that while the stress from his illness was bad, the accumulating medical bills made it worse. It became clear to Butler that his insurance had no intention of paying. In total, Butler faced more than $43,000 in medical bills.
Charley’s wife, Chloe, said that she tried calling the number on the back of the insurance card and got the runaround. She was transferred from department to department and told that the claims were still being processed.
Two months after Butler began treatment, his insurance company asked for further information about his medical history. The Butlers would later learn that the requested information was part of a recession review, which was an attempt to unearth medical history that was not disclosed at the time of purchase and used as grounds for policy cancelation.
Instead of paying the thousands of dollars in medical bills, Butler’s insurance canceled his plan, citing a preexisting medical condition. While the Affordable Care Act protects consumers with preexisting conditions, short-term limited-duration insurance plans, like Butler’s, are exempt from the regulation.
“Unfortunately, companies are taking advantage of the fact that consumer protections required by the Affordable Care Act don’t apply to these plans,” said former California Insurance Commissioner Dave Jones, who participated in several national investigations of short-term plans. “The kind of things we are seeing with these short-term plans look like what we used to see across the board.”
Georgetown University Center on Health Insurance Reforms’ Diana Palanker says that many consumers, like Butler, assume that all health plans now cover preexisting conditions and don’t think to ask. Butler’s 25-page policy included 45 exclusions and limitations, not to mention the fact that Butler’s plan actually had no in-network providers, meaning all providers could charge him more for his care.
Thankfully for Butler, his cancer went into remission and he found a more comprehensive plan on Montana’s marketplace. The premium is twice what he paid in 2016, but he says he learned his lesson about short-term plans.
“As much as I like to whine about Blue Cross Blue Shield, I’ll take them every day over what I had,” Butler said.