Medical Insurance Mess

Seven On Your Side
August 9, 2010 6:39:37 PM PDT
The volunteer firefighter endured 2 years of pain - but after emergency surgery cure her another discomfort from her insurance company. It was up to 7 on your side to ease her pain. Barbara Bender is used to emergencies. She's put out fires in Deer Park as a volunteer firefighter. And for the past 3 decades she's been a 9-1-1 operator in Babylon. But in December of last year, it was Barbara who needed help.

"On a pain scale from 1 to 10, it was a 12," recalled Barbara. (I had) severe cramping." The pain was severe she needed 2 dozen Advils just to get through the day. "I would lay in my bed with a heat pack, curled in the fetal position."

Her gynocologist ordered a hysterectomy. So she got pre-approval from her insurer, Emblem Health, and last year Barbara went in for surgery. But there were complications.

"When I woke up the nurses in the recovery room had told me we had to cut you open from hip to hip," said Barbara.

While under anesthesia, she needed emergency abdominal surgery. Another surgeon had to be called in. Thankfully, the surgery worked but months later.

"I thought it was crazy." And then a different pain hit Barbaa, this time in her wallet. A bill for more than $5,300 bill for the emergency surgeon.

But it wasn't covered by her insurance company, Emblem Health, because the doctor was out of her insurance plan's network.

"I'm lying on the table, on an operating table, when, under anesthesia, you know, the luxury wasn't there to sort of have the doctor in my plan."

So Barbara appealed, twice. Both times her insurer denied. It was time Barbara dialed 9-1-1 for 7 On Your Side. And after our call to Emblem Health...

"I was flabbergasted."

Emblem took a third look at Barbara's case and agreed to pay more than $5,200.

"So in 3 days you had accomplished here what I was trying to do for 6 and a half months."

Emblem Health told us they reconsidered their past denials because Barbara's procedure was considered "emergency" service, which is mostly covered. Emblem paid all but $150 of her bill. Remember, patients can appeal insurance company's denials, and if that doesn't work they can appeal to your state's insurance department.


Story by: Nina Pineda

Produced by: Steve Livingstone CONNECT WITH NINA PINEDA AND 7 ON YOUR SIDE