Friday, March 20, 2009

Utah Mom Pays Health Insurance Premiums Faithfully, But Core Innovative Solutions Refuses To Pay $20,000 Hospital Bill After C-Section Birth

KUTV Channel 2 is reporting on a bureaucratic nightmare where nobody's really at fault - except the people who wrote the laws. A Utah mother identified as Melanie had health insurance through her former employer, The Garden Lodge. The Lodge closed down in late 2008, and Melanie was laid off. The Lodge's sister company, Behunin Horticulture, also used the same health insurance carrier, which was Core Innovative Solutions. To maintain the coverage, Melanie worked through COBRA, and got assistance to continue the coverage. She faithfully paid monthly premiums of $193.80. So when she ran up a bill of $19,597.40 as a result of a C-section delivery, she submitted the bill to Core in full confidence that it would be paid.

NOT!!! They refused to pay the claim, instead sending back Melanie's January premium payment of $193.80. Bankruptcy loomed! What happened was that Behunin Horticulture changed carriers, and did not inform Melanie. But Behunin did not know that Melanie was still paying premiums to Core, and Core did not inform Behunin of this.

Fortunately, the Utah Consumer Health Assistance office found the specific COBRA regulation which requires the new carrier to pay the hospital bill. So all ends well - this time.

Behunin's not the "bad guy"; they didn't know Melanie was still paying the old carrier. Core's not the "bad guy"; they had no obligation to inform Behunin that Melanie was still paying them. So can you really blame Core for refusing to pay the claim? After all, they did return her premium (I wonder why Core didn't take the initiative to notify Melanie themselves, though?). Melanie was simply a bureaucratic casualty in a complex, Byzantine system.

Even single-payer socialist health care would be an improvement over this mess, as much as I hate socialism.

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