Last fall, Larry Basich signed up for health insurance through the Nevada Health Link exchange.
He started working on the enrollment process on October 1, the first day his state’s exchange went live. Website glitches prevented him from being able to complete the sign-up process until mid-November.
Basich paid his first premium in November, and has been paying monthly ever since. His coverage was supposed to begin on January 1.
As the weeks passed by, Basich grew concerned about his coverage because he didn’t receive any sort of confirmation. Nevada Health Link kept saying he had coverage, but UnitedHealthcare said he wasn’t in their system.
On December 31, Basich had a heart attack.
On January 3, he had triple bypass surgery. His medical bills for January and February come to $407,000.
Who is going to cover those bills has yet to be determined, as the Las Vegas Review Journal explains:
Basich and his insurance broker, Tamar Burch of Branch Benefits Consultants, said the issue appears to be confusion at the state exchange. Xerox’s system says Basich chose a plan from another insurer, Nevada Health CO-OP, even though Basich has paperwork that shows he selected MyHPNSilver1. In short, Xerox can’t seem to decide where Basich belongs, Burch said.
So the exchange is trying to compromise, putting Basich with Nevada Health CO-OP for January and February, when he incurred his bills, and with UnitedHealthcare from this month on. But CO-OP officials say Basich is not their member.
Nevada Health CO-OP CEO Tom Zumtobel told the exchange board on Feb. 27 that the nonprofit carrier spent seven days with Xerox determining Basich’s eligibility, only to find that Basich hadn’t chosen the group’s coverage.
“If he had picked our health plan, we would be advocating for a solution. But he didn’t pick us,” Zumtobel said. “We need someone on the board to advocate for him.”
Burch said Xerox is not equipped to handle these kinds of issues, and is busy lawyering up, even though Basich hasn’t retained a lawyer and has not threatened to sue.
“Xerox is truly out of their league. They need to understand they are an administrator, they are not an insurance company. They need to understand their boundaries. They don’t understand this world. Everybody is at the mercy of Xerox, and they are not doing this right.
“I believe Xerox is covering themselves because of a huge system error. They don’t want the accountability of saying, ‘Yes, we did mess this up, and here’s the plan you selected.’ It’s like, ‘What did he pay for?’ That’s it. They are making this more complicated than it has to be.”
Burch added that Xerox is trying to place blame on Basich:
She said a Xerox executive tried to throw blame on Basich for writing four different applications with four separate sets of information.
“I said, ‘Larry’s not the only one who did that. Lots of people have created multiple applications. Nothing is concrete until people pay. If you have a problem with multiple applications, then you’ll have to come to our office and take back hundreds of cases.’”
She said what happened to Basich is not unusual. She estimates that only 5% of the approximately 200 of her firm’s clients have not experienced enrollment issues, and more than 20 have had the same plan confusion issue as Basich.
Basich, who is retired and moved from Hawaii to Nevada in 2012, said he didn’t expect to have to deal with all of this stress:
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“All I wanted to do when I moved here was buy a house, get a dog and go to some spring training games for the Dodgers.”