Couple Struggles Through Multiple Surgeries, Only To Find Insurer Won't Pay
Penn Valley, California
In April 2000, Darlene and Dave Henderson met with a salesman for the National Association for the Self-Employed. He sold them an association health plan with Mega Life, which they thought was like a group PPO similar to others they had seen.
Soon after, David Henderson required surgery for a life-threatening aneurysm and a subsequent colostomy. Darlene went through her own ordeal with breast cancer. In all, the Hendersons had three surgeries each in a nine-month period at a total cost of over $190,000.
They learned that their "association" health plan did not protect them like a group policy would, and that its maximum benefits were very low in relation to typical medical expenses. Mega paid just 14% of Dave's medical bills.
Here is Dave's statement on his junk health insurance.
"About the time Darlene and I reached age 57, we found ourselves in circumstances familiar to most of our peers ' too old for high-paying jobs and low-cost insurance; and too young for retirement and Medicare. Furthermore, while our son and daughter had married and left the nest, we were caring for Darlene's elderly parents and a great aunt. This situation has become a societal trend.
"In April, 2000, we joined a business group called the National Association for the Self-Employed, specifically to obtain their $1,000,000 health insurance plan, which its salesman told us would cover 80-100 percent of "usual and customary" charges for hospital and surgical expenses.
"From August 2000 until May 2001, Darlene and I underwent six surgeries (three each) that cost about $220,000. Our insurer, Mega, rejected many claims and paid scant amounts on others, leaving us with $180,000 in unpaid medical debts. Their 80-100 percent coverage of "usual and customary" expenses ended up to be less than 15 percent of actual charges. Moreover, we learned that NASE actually was not an independent organization, but instead had direct ties to Mega. And the "group" plans were actually individual policies without any clout.
"Since then, our outstanding medical balances have grown with interest to well more than $200,000, and we are among those who have been suing the insurance company in at least six states.
"Darlene and I, having barely survived our medical catastrophes, were then rendered uninsurable for about three long years until we qualified for Medicare. During those years and even today, we find ourselves avoiding doctors "at all costs."
"There can be no room for junk health insurance that doesn't cap the amount of money a patient has to pay out of pocket.
"The United States government supposedly guarantees the rights to life, liberty, and the pursuit of happiness. Yet, all those rights are meaningless without proper health care. The U.S. Congress should be doing something to stop other people from being cheated with junk insurance policies, not expand them as Senator Enzi's bill would do."
Read the Sacramento Bee article about the Hendersons' experience.