Insurer began review of woman's records to look for pre-existing conditions, stalling payments What's Your Problem?
September 29, 2009
For a fleeting moment, Romy Kaminski pondered the idea of forgoing health insurance.
The 36-year-old Romeoville resident had just been laid off, and she knew she couldn't afford the $1,300 a month in COBRA payments for her family. She thought perhaps she could hold off until she got another job.
After sleeping on it a night, Kaminski changed her mind and decided she needed a safety net. On Feb. 1, she signed up for a no-frills, $225-a-month, catastrophic-only health insurance policy with Assurant Health.
But when catastrophe struck in March in the form of an out-of-the-blue brain aneurysm, Assurant balked on paying.
With Kaminski's medical bills totaling $279,721.14 and growing, the hospital sent her a letter this month demanding immediate payment.
"I never once in my mind thought this would be a problem," Kaminski said last week after contacting What's Your Problem? for help. "This is why I bought health insurance."
Kaminski's journey through the health insurance quagmire began after she suffered a series of excruciating headaches in February. The headaches were so severe that she spent three days in the hospital while doctors ran tests. The doctors found nothing abnormal and ruled that the episodes were intense migraines.
A month later, on March 13, Kaminski was waiting for a cab outside a hotel on Rush Street when she again was buckled by pain.
"It felt like someone had shot me with a gun in the back of my head," Kaminski said. "I said a lot of profanity. Then I passed out."
When she awoke, she was lying on the ground with paramedics hovering over her. She was taken by ambulance to Northwestern Memorial Hospital, where doctors discovered a ruptured aneurysm in her brain.
After emergency surgery, Kaminski spent almost two weeks in intensive care. She returned home, but later tests revealed the aneurysm had returned. On June 18, she had another surgery.
By then, she already knew she was in for a fight with Assurant. On May 14, she received a letter from Northwestern saying Assurant had not yet paid more than $200,000 in claims from her March surgery. The letter said the insurance company had embarked on a "pre-existing investigation."
Kaminski, a former benefits administrator for an insurance broker, took that as bad news.
"They're stalling, stalling, stalling," she said. "Delay and don't pay, that's their tactic."
More than four months after Assurant launched its investigation, the insurance company still was reviewing Kaminski's file, looking to see if there was anything in her past that would disqualify her for benefits.
If Assurant does not pay, Kaminski said, she would probably be forced to file for medical bankruptcy.
"I'm not scared because I don't have the money, so you can't make me pay something that's not there," she said. "You can't get blood from a turnip. I'm still laid off."
Kaminski said she's tried calling Assurant, but no one there will give her answers.
"I won't give up," she said. "I'll never assume responsibility for these bills no matter what it takes because I did the right thing and I insured myself in case of an emergency, and there was an emergency."
On Sept. 22, the Problem Solver called Peter Duckler, a spokesman for Milwaukee-based Assurant.
Duckler said privacy rules prevented him from discussing Kaminski's case. "We can never comment on an insured's coverage due to confidentiality issues," he said.
Still, Assurant took a fresh look at Kaminski's case.
On Thursday, a company representative called Kaminski and told her Assurant still hadn't received some of her medical records from Northwestern. The Problem Solver called Northwestern, which sent the records later that day.
On Friday, another Assurant representative called Kaminski and told her it had completed the review of her file. The representative told her the insurance company would start processing her claims immediately.
All $279,721.14 of them.
"They're going to pay them, it sounds like," a relieved Kaminski said.
Kaminski said she still hasn't received all of her bills, including several from her June surgery. Those likely will tack on thousands more dollars to her grand total.
No matter the tally, Kaminski said, she will only have to pay $5,000, which includes her $2,500 deductible and her plan's $2,500 out-of-pocket maximum.
"I'm smart," Kaminski said. "I made sure I was covered."
She also made sure she did not continue with Assurant. Kaminski said her original six-month policy expired at the end of July. After that, she went back on her former employer's HMO plan through COBRA.
SOURCE:http://www.chicagotribune.com/news/columnists/chi-tue-problem-insurance-0929sep29,0,1926150.column
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