In Your Corner: Insurance Frustration

By Ryan Elijah

June 18, 2010 Updated Oct 2, 2009 at 9:21 AM EDT

After graduating with a degree in Biology, Kendallville's Niccole Van Hoey needed surgery for a torn meniscus, the procedure was covered under her parents insurance. In January, she had to get her own policy and decided on Assurant Health, but they denied treatments due to a "pre existing condition".

An MRI revealed another surgery was required, so the Van Hoey's researched policies and settled on Cinergy Health, expecting the company to pay 80 percent of the surgery. When Lutheran Hospital checked with Cinergy, the Van Hoey's were shocked to learn the surgery was covered, but not the facility, leaving Niccole with almost 10-thousand dollars in expenses.

Niccole Van Hoey "I'm paying for insurance to get coverage and then they turn around and they don't cover me, it's just really frustrating"
Rosemary Van Hoey "it's not what it says, it's what it doesn't say in the policy"
As a minimum wager earner, Niccole couldn't afford the cost of surgery, fortunately for her both Parkview and Lutheran hospitals found a program that would reduce her costs. Jeff Francis is the Chief Financial Officer for Parkview Health, he urges patients to talk to the hospital and insurance company before the procedure to see what's covered. Both hospitals offer payment plans and charity programs, Parkview has nearly 40 people that deal with billing issues and Jeff Francis admits the healthcare industry isn't simple.
"it's a difficult industry with the insurance companies between patients and hospitals"
We contacted the Florida company, Cinergy Health for clarification on Niccole's policy. They stated that "facility charges are not specifically designated by the policy for coverage" and that the policy has **no** benefits listed for outpatient facility charges", they also released to us a transcript from the phone call that registered Niccole into the program, saying the benefits were explained.
When took a deeper look at the company, and found Cinergy has 160 complaints on file with Florida's Better Business Bureau. We also found hundreds more venting online about policies that weren't paid as they felt they were advertised.
7 weeks ago, the New York Insurance department fined American Medical and Life Insurance Company 700-thousand dollars for misleading sales of *limited* insurance plans. Cinergy Health was listed in the filing as an intermediary of the company used in a nationwide marketing campaign. Cinergy did try to contact Niccole after our inquiry, she is now recovering from her 2nd surgery.
The Van Hoey's have written to a number of government officials but only Senator Dick Lugar's office has responded. They've also filed a complaint with the Indiana Department of Insurance, that agency tells Indiana's NewsCenter they are still investigating, but nothing has been formally filed at this time.
One in Seven Allen County residents have no insurance, but according to CANI only about 2800 take advantage of Indiana's H.I.P. program. A state funded insurance fair will be held October 14th from 2-6pm at the Anthony Medical Center.

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