College student's lesson in claims.
Student gets unexspected tutorial on health insurance.
Julia Howey lay on the floor of her college apartment in June, heart
pounding, frantic. She wanted to go to the ER but resisted.
Was she having an anxiety attack, or something worse? She wasn't sure,
but she thought she had exceeded her insurance coverage. Already with
$15,000 in medical bills this year, and $30,000 in student loans, she
couldn't afford any more debt.
"I just prayed to God for it to pass," she said of her pounding heart.
Three hours later, her heartbeat returned to normal.
Howey's insurer had denied payments on earlier visits this year to the
emergency room for kidney stones and anxiety attacks, so all the bills
were coming to her. She knew she had insurance, and was confused by the
whole billing process. Collection agents called and texted her daily.
"What's hard is I have people calling me about bills I haven't paid,"
she said. "My thought is always I have no way to pay. It has caused me
so much stress emotionally. "
Howey, 24, a Chestnut Hill resident and student at Millersville
University near Lancaster, is trying hard to make her own way in life.
She carries a 3.5 GPA, a full-time course load, and works 25 hours a
week, not to mention participating in several campus clubs and
activities. She dreams of singing on Broadway and opening a recording
studio for inner-city children to give them opportunities to get their
music out there.
Howey had health issues growing up, a condition called polycystic
ovarian syndrome - cysts form in the ovary that can lead to infertility.
The disease also creates hormonal imbalances, weight gain and skin
problems. She is certain this contributed to her teenage depression.
"It was insanely difficult to deal with," Howey recalled.
Her father is a government employee and has good insurance, so most
bills back then were just paid by the insurance company.
After high school, Howey decided to take a couple of years to work and
get herself together. She got health insurance through her job at a car
dealer but gave it up when she headed to Millersville.
"We took out a school policy," said her mother, Karen Howey. "Being
naive about insurance because I've never really had to deal with it, I
told her to look into it. We sent a check and thought we were covered in
most cases. "
The policy was with Consolidated Health Plans of Massachusetts and cost
$1,200 for the calendar year.
Julia's insurance woes began Jan. 12, just before she headed back to
school from winter break.
Julia went to Chestnut Hill Hospital's emergency room.
She had kidney stones.
She believes this was related to her ovarian syndrome, but there is no
scientific evidence proving that, she says.
The hospital sent her home after many hours and tests - with painkillers
but without passing the stone.
The next day, at school, she went to a Lancaster hospital, still in
agony. "They sent me home to pass it, in a dorm, with a shared public
bathroom, and they gave me Vicodin for the pain," she said.
A month or so later, Julia got a bill from Chestnut Hill Hospital for
$8,068.
The insurance company denied the hospital's claim, so the hospital
billed Julia.
More bills came, $531 on Jan. 13 from the Lancaster hospital. And
another denial from the insurer.
Julia and her mother ignored the bills, hoping they would resolve
themselves. But then more bills came, and Julia made two trips to the
emergency room in April with chest pains, fearing she was having a heart
attack, but apparently these were anxiety attacks.
"We started getting bills from the hospital and denials from the
insurance company," Karen said. "I called the insurance company. 'Oh,
she's already tapped out from her first emergency visit. That's all she
gets for the year. ' I'm sitting here with a stack of bills. You get a
different bill for everything. About $10,000 worth of medical bills. We
just had no idea. No idea this would happen. "
That's when Karen told Julia that she had exceeded her coverage, and
that she shouldn't go to the hospital unless she absolutely had to.
That's why Julia lay on her floor in June rather than getting help.
Soon, the bills totaled $15,000.
Over the summer, Julia's mother plunged into insurance hell. Karen, 54,
had been laid off three years earlier after a career as a children's
fashion designer. She had time to untangle the mess.
Karen created folders for every hospital visit. She sat on the phone
hour after hour with the insurance company, sorting stacks of paperwork,
matching bills with insurance statements.
"It's like a science project," she said.
"Just insane," she added. "There's no way Julia could have handled this.
And I'd put it off because I didn't understand.
Drew DiGregorio, director of sales and marketing for Consolidated Health
Plans, said that for nine of 10 students, this is their first exposure
to insurance. "We try to dumb it down as much as we can, but it's
difficult," he said.
Under most employer-based policies, he said, a person is covered for a
maximum. No matter what's wrong, you get so much coverage and that's it.
In this plan, he said, you get so much coverage per sickness or injury,
so his company needed a claim from Julia for each hospital visit.
His company wouldn't pay any claims until Julia filed her own claim
form.
Karen eventually figured this out.
"I want to teach health insurance 101," she says now. "What the parent
needs to know and needs to do. "
"Just the number of people and amount of paperwork involved in each
claim," Karen said, "it must cost millions of dollars. "
After everything was processed and claims were paid, Karen whittled
Julia's bills down below $5,000.
The mother also tried this summer to find different and better policies
for her daughter.
But every insurer she contacted told her it wouldn't cover Julia's
preexisting conditions for at least a year. And still they wanted $400 a
month in premiums, which Julia can't afford.
So Julia signed up again this year for the same plan.
"I know it sounds crazy, but at least I understand how things work now,"
her mother said, "and they will cover her for kidney stones and other
problems. "
Under this plan, Consolidated cannot exclude anyone for a preexisting
condition.
Julia will still go without prescription skin creams and medications
because her plan has little or no prescription coverage and she can't
afford them.
She is in her fourth semester now. On Tuesdays and Thursdays, she has
class all morning, works from noon to 5 p.m. in the student-aid office,
has class in the evening and then attends meetings, practices or
rehearsals for many campus activities - clubs, choirs, the Fall
Showcase.
"I was sent to the ER two weeks ago," she said recently in an e-mail. "I
had a cyst rupture on my ovaries. "
This time, she submitted her own claim form.
She tries not to let health and insurance problems drag her down.
"What I want more than anything is to have children and a family," she
said.
"There will be so many steps, in vitro fertilization, other things.
They're not covered by insurance with my preexsiting condition.
"In my head I'm thinking, how will I ever be able to get the things I'll
need if I can't even afford a face cream? "
Contact staff writer Michael Vitez at 215-854-5639 or
mvitez@phillynews.com.
What Went Wrong
Julia Howey bought health insurance for $1,200 a year through
Millersville University, and thought she was covered. But after she
needed emergency care, bills poured in from hospitals and doctors,
putting her $15,000 in debt. Her mother, who spent days unraveling the
bills, found that Howey had to submit her own claims for providers to be
paid. Howey, who hopes to have a family, despairs of finding coverage in
the future. The case shows how even college students can get caught up
in insurance gaps.
Next Installment
Ruby Spencer has a 14-inch-long tumor in her abdomen, which makes the
trim, 60-year-old widow look pregnant. She has no health insurance, and
has been unable to get tests to assess the tumor or surgery to remove
it. She has bounced from clinic to county assistance office to emergency
room, where staff also sent her home.
philly.com
For Michael Vitez's blog, and previous stories in this series, go to
http://go.philly.com/uninsured
pounding, frantic. She wanted to go to the ER but resisted.
Was she having an anxiety attack, or something worse? She wasn't sure,
but she thought she had exceeded her insurance coverage. Already with
$15,000 in medical bills this year, and $30,000 in student loans, she
couldn't afford any more debt.
"I just prayed to God for it to pass," she said of her pounding heart.
Three hours later, her heartbeat returned to normal.
Howey's insurer had denied payments on earlier visits this year to the
emergency room for kidney stones and anxiety attacks, so all the bills
were coming to her. She knew she had insurance, and was confused by the
whole billing process. Collection agents called and texted her daily.
"What's hard is I have people calling me about bills I haven't paid,"
she said. "My thought is always I have no way to pay. It has caused me
so much stress emotionally. "
Howey, 24, a Chestnut Hill resident and student at Millersville
University near Lancaster, is trying hard to make her own way in life.
She carries a 3.5 GPA, a full-time course load, and works 25 hours a
week, not to mention participating in several campus clubs and
activities. She dreams of singing on Broadway and opening a recording
studio for inner-city children to give them opportunities to get their
music out there.
Howey had health issues growing up, a condition called polycystic
ovarian syndrome - cysts form in the ovary that can lead to infertility.
The disease also creates hormonal imbalances, weight gain and skin
problems. She is certain this contributed to her teenage depression.
"It was insanely difficult to deal with," Howey recalled.
Her father is a government employee and has good insurance, so most
bills back then were just paid by the insurance company.
After high school, Howey decided to take a couple of years to work and
get herself together. She got health insurance through her job at a car
dealer but gave it up when she headed to Millersville.
"We took out a school policy," said her mother, Karen Howey. "Being
naive about insurance because I've never really had to deal with it, I
told her to look into it. We sent a check and thought we were covered in
most cases. "
The policy was with Consolidated Health Plans of Massachusetts and cost
$1,200 for the calendar year.
Julia's insurance woes began Jan. 12, just before she headed back to
school from winter break.
Julia went to Chestnut Hill Hospital's emergency room.
She had kidney stones.
She believes this was related to her ovarian syndrome, but there is no
scientific evidence proving that, she says.
The hospital sent her home after many hours and tests - with painkillers
but without passing the stone.
The next day, at school, she went to a Lancaster hospital, still in
agony. "They sent me home to pass it, in a dorm, with a shared public
bathroom, and they gave me Vicodin for the pain," she said.
A month or so later, Julia got a bill from Chestnut Hill Hospital for
$8,068.
The insurance company denied the hospital's claim, so the hospital
billed Julia.
More bills came, $531 on Jan. 13 from the Lancaster hospital. And
another denial from the insurer.
Julia and her mother ignored the bills, hoping they would resolve
themselves. But then more bills came, and Julia made two trips to the
emergency room in April with chest pains, fearing she was having a heart
attack, but apparently these were anxiety attacks.
"We started getting bills from the hospital and denials from the
insurance company," Karen said. "I called the insurance company. 'Oh,
she's already tapped out from her first emergency visit. That's all she
gets for the year. ' I'm sitting here with a stack of bills. You get a
different bill for everything. About $10,000 worth of medical bills. We
just had no idea. No idea this would happen. "
That's when Karen told Julia that she had exceeded her coverage, and
that she shouldn't go to the hospital unless she absolutely had to.
That's why Julia lay on her floor in June rather than getting help.
Soon, the bills totaled $15,000.
Over the summer, Julia's mother plunged into insurance hell. Karen, 54,
had been laid off three years earlier after a career as a children's
fashion designer. She had time to untangle the mess.
Karen created folders for every hospital visit. She sat on the phone
hour after hour with the insurance company, sorting stacks of paperwork,
matching bills with insurance statements.
"It's like a science project," she said.
"Just insane," she added. "There's no way Julia could have handled this.
And I'd put it off because I didn't understand.
Drew DiGregorio, director of sales and marketing for Consolidated Health
Plans, said that for nine of 10 students, this is their first exposure
to insurance. "We try to dumb it down as much as we can, but it's
difficult," he said.
Under most employer-based policies, he said, a person is covered for a
maximum. No matter what's wrong, you get so much coverage and that's it.
In this plan, he said, you get so much coverage per sickness or injury,
so his company needed a claim from Julia for each hospital visit.
His company wouldn't pay any claims until Julia filed her own claim
form.
Karen eventually figured this out.
"I want to teach health insurance 101," she says now. "What the parent
needs to know and needs to do. "
"Just the number of people and amount of paperwork involved in each
claim," Karen said, "it must cost millions of dollars. "
After everything was processed and claims were paid, Karen whittled
Julia's bills down below $5,000.
The mother also tried this summer to find different and better policies
for her daughter.
But every insurer she contacted told her it wouldn't cover Julia's
preexisting conditions for at least a year. And still they wanted $400 a
month in premiums, which Julia can't afford.
So Julia signed up again this year for the same plan.
"I know it sounds crazy, but at least I understand how things work now,"
her mother said, "and they will cover her for kidney stones and other
problems. "
Under this plan, Consolidated cannot exclude anyone for a preexisting
condition.
Julia will still go without prescription skin creams and medications
because her plan has little or no prescription coverage and she can't
afford them.
She is in her fourth semester now. On Tuesdays and Thursdays, she has
class all morning, works from noon to 5 p.m. in the student-aid office,
has class in the evening and then attends meetings, practices or
rehearsals for many campus activities - clubs, choirs, the Fall
Showcase.
"I was sent to the ER two weeks ago," she said recently in an e-mail. "I
had a cyst rupture on my ovaries. "
This time, she submitted her own claim form.
She tries not to let health and insurance problems drag her down.
"What I want more than anything is to have children and a family," she
said.
"There will be so many steps, in vitro fertilization, other things.
They're not covered by insurance with my preexsiting condition.
"In my head I'm thinking, how will I ever be able to get the things I'll
need if I can't even afford a face cream? "
Contact staff writer Michael Vitez at 215-854-5639 or
mvitez@phillynews.com.
What Went Wrong
Julia Howey bought health insurance for $1,200 a year through
Millersville University, and thought she was covered. But after she
needed emergency care, bills poured in from hospitals and doctors,
putting her $15,000 in debt. Her mother, who spent days unraveling the
bills, found that Howey had to submit her own claims for providers to be
paid. Howey, who hopes to have a family, despairs of finding coverage in
the future. The case shows how even college students can get caught up
in insurance gaps.
Next Installment
Ruby Spencer has a 14-inch-long tumor in her abdomen, which makes the
trim, 60-year-old widow look pregnant. She has no health insurance, and
has been unable to get tests to assess the tumor or surgery to remove
it. She has bounced from clinic to county assistance office to emergency
room, where staff also sent her home.
philly.com
For Michael Vitez's blog, and previous stories in this series, go to
http://go.philly.com/uninsured
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