Here's my story
My battle with cancer, an insurer that canceled my coverage because I got sick, and tens of thousands of dollars of debt started out as a compassionate joke.
My father was having health problems that his doctor didn’t understand, so I suggested that he go get a full body scan, something my mother had done a few years ago. Sometimes it finds hidden things.
Last Christmas, he said, OK, “I’ll do it if you do it.” He was more than a little nervous so I decided to humor him. I called the clinic where my mother had gone and they said it would be a couple of months, unless we would go Friday the 13th of January. We’re not superstitious, so that was fine with us. A friend and his wife went with us as well.
I thought I was there just to support my Dad. Unlike him, I didn’t even order a consultation with the doctor afterward. This was his appointment, not mine. About a week later, we went in to go over his results, and the doctor said my dad was fine but that she needed to talk with me. She said there was something odd, and that she wanted me to do an abdomen scan that would provide more detail.
We did that on Jan. 31. I got the results on Feb. 3 over the phone. They said there was a definite tumor on my right kidney and they thought I should get right to my doctor. There was no discussion yet of cancer. At that moment, I was certainly grateful that my new insurance with PacifiCare had kicked in. They approved it on Jan. 24, taking effect Feb. 1. It wasn’t until a good deal later that I learned that I had an aggressive form of kidney cancer and that one of my kidneys would have to be removed. This was done May 12.
I had first visited with my insurance broker in November, and after some back and forth he persuaded me to go with PacifiCare. I filled out the application Jan. 10, but on Jan. 18 he told me I had to submit an updated 2006 form. But he told me just to fill out the authorization pages and
he’d fill out the rest from my previous application.
On Aug. 13, I got a cancellation notice from PacifiCare. It said that I knew when I applied that I had kidney cancer, and accused me of fraud. If they had called the agent they would have learned I started the enrollment process in November, and the agent knew I was going to have the scan.
But I wasn’t diagnosed with cancer until after the coverage actually started. If I’d known I was ill, wouldn’t I have bought something better than a crummy HMO?
At the end of August, I received my regular monthly premium notice for the month of September. I sent the payment certified mail with return receipt and they cashed the check right away. When I did not receive the October premium notice, I sent the October payment to them
certified mail with return receipt. I know they received it but have not received confirmation if they had cashed this payment yet.
Also in August, I received two certificates from Pacificare. The first certificate was for HIPAA coverage which is useless since I need 18 months of prior coverage for HIPAA to apply. The second certificate was proof of previous prescription drug coverage so that I won’t get a penalty when I apply for Medicare Plan D coverage. This seemed odd since I won’t be eligible for Medicare until the year 2037. Since I signed up for coverage with Pacificare, I have also received an AARP card and a letter from Liberty telling me how they can deliver my Medicare drugs right to my home. Why they think I am eligible for Medicare is beyond me.
In addition, not only have I had to put with PacifiCare’s illegal, arbitrary cancellation of my policy, but my doctors failed to accurately diagnose my cancer, delaying the correct treatment and wasting precious time. As if that wasn’t enough, PacifiCare refused to pay the bills for my
kidney surgery by the experts at the Cleveland Clinic because it was not in the company’s network. PacifiCare didn’t tell me that it wouldn’t cover the surgery until the day before the operation, waiting until after I had already traveled across the country, and contradicting the recommendation of my in network doctor.
I also found out that since I didn’t have the PacifiCare insurance for 18 months, all other insurers could deny me coverage for having a preexisting condition. Now I am impossible to insure. Brokers tell me I’ll “never be covered.”
I have paid out of pocket for lung and abdomen scans and I’m supposed to have them every six months—for life. Together, they are $1,000 each time. I still have to figure out how to deal with $25,000 I owe my parents for a loan they gave me to partially pay for the $60,000 surgery that
PacifiCare denied. I don’t know what the future will hold.
I’m self-employed, and still not working as much as before all this. The only good thing about this story is that my Dad saved my life. My chances of survival are much better with the early detection. For that I’m grateful. The question now is how can I afford to stay healthy?
SBD
wish you the best of health and please RIP THEM A NEW ONE.
The fact that they were slow to notify you of the coverage decision doesn't speak well for how well Pacificare is run, but it isn't surprising that they refused to cover something that was out of network, and it hardly sounds illegal. How far in advance had you asked them if they would cover the surgery?
As for canceling your policy, Pacificare certainly had no way of knowing that you tried to apply in early January (the fact that you talked with your agent about it in November is not relevant). As far as they knew, you applied after January 20 (when they finally got the forms), when you already knew from your scan that there were some problems. It may be your agent's fault that the forms were not in by early January, since he gave you the wrong ones, but I really don't know if Pacificare has a legal obligation to grant you coverage unless you can prove that you didn't know you had cancer until after your final application was submitted. Did you explain the application situation to them after you found out they were canceling?
UHC is under investigation by SEC for post dating all those big stock options..while our premiums continue to rise.
I had cancer surgery under UHC coverage and they wouldn't pay for all the post op slide work. I had to pay for that.
They really didn't want more info to make the treatment more effective or targeted. I am lucky..survived three years now and almost out of the woods.
UHC is generally slow pay and looses the first claim.
So Dr. charge them higher rates in their contracts.
See Wall Street article on their problems..they need to restate earnings.
If you can't work like you use to you should file for Social Security Disability. After two years on that you will also be covered by medicare. Most people who file for disability can also go on their states medicaid program until their disability is approved.
It doesn't sound like there is an easy fix for your problem. I hope that your attorney is competent. I think that you should take a closer look at including the medical group in your litigation. It sounds like they really dropped the ball.
Most important, don't let the fight consume you, you need your strength. I don't imagine that you will get many replies to this post as a Trula substantive reply requires more facts. It might be worth contacting the hospital where the surgery was performed to see if there is any grant money or other assistance available. An irony of the way hospitals work is that the private pay patient gets to pay almost twice as much as an insurance company would pay for the same service.
Good luck!
good luck with the suite, I's go after the Dr too
When you insure with Pacificare, be prepared to spend a large chunk of your life trying to get them to fix bonehead errors. From my perspective, the company is entirely staffed by tree sloths.
How much does a full body scan cost?