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Obamacare leaves Las Vegas man owing $407,000 in doctor bills


               
2014 Mar 18, 4:20am   2,573 views  21 comments

by zzyzzx   follow (9)  

http://www.reviewjournal.com/news/obamacare-leaves-las-vegas-man-owing-407000-doctor-bills

The hospital bills are hitting Larry Basich's mailbox.

That would be OK if Basich had health insurance. But he doesn't.

Thing is, he should be covered. Basich, 62, bought a plan through the state's Nevada Health Link insurance exchange in the fall. He's been paying monthly premiums since November.

Yet the Las Vegan is stranded in a no-man's-land where no carrier claims him, and his tab is mounting: Basich owes $407,000 for care received in January and February, when his policy was supposed to be in effect. Instead, he's covered only for March and beyond.

Basich has begged for weeks for help from the exchange and its contractor, Xerox. But Basich's insurance broker said Xerox seems more interested in lawyering up and covering its hide than in working out Basich's problems. Nor is Basich the only client facing plan-selection errors through the exchange, she added.

Xerox, meanwhile, said it's working every day to fix Basich's problem, and its legal counsel is routine.

In the rollout of the Affordable Care Act and its insurance exchanges, you can find a success story for every failure. But Basich's case is extreme.

WHO'S RESPONSIBLE?

Basich said he began trying to enroll on Oct. 1, the day the exchange website went live. Like many consumers, he fought technical flaws during multiple sign-up attempts. In mid-November he finally got through and chose his plan: UnitedHealthcare's MyHPNSilver1.

“It was like reaching the third level of Doom,” Basich said of the torturous sign-up process.

Basich paid his first premium on Nov. 21, and within days the exchange withdrew the $160.77 payment from his money-market savings account. Because Basich paid a month before the Dec. 23 deadline, his coverage was to begin Jan. 1.

Weeks ticked by, but Basich received nothing to confirm he had insurance. Nevada Health Link kept telling him he was enrolled, but UnitedHealthcare said he wasn't in their system.

Basich's predicament went critical on Dec. 31, when he had a heart attack. His treatment, which included a triple bypass on Jan. 3, resulted in $407,000 in medical bills in January and February that no insurer is covering.

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.”

Why have four months passed without a resolution?

“Xerox is truly out of their league. They need to understand they are an administrator, they are not an insurance company,” Burch said. “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.”

Xerox representatives responded that they're working hard to make it right.

“Mr. Basich's issue is complex, and we're working on it every day. We are in touch with Mr. Basich, his broker, the carriers, (Silver State Health Insurance Exchange) leadership, and the Division of Insurance to sort it out,” said spokeswoman Jennifer Wasmer.

The help didn't come fast enough, said Basich, who blames his back-and-forth with the exchange in December at least in part for stress that caused his heart attack. That stress has turned up a few notches now that Basich is getting the bills. He fretted in the exchange board's Thursday meeting about what will happen to his credit rating — and his ability to qualify for a mortgage — if the bills are not covered.

“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,” said Basich, who moved to Las Vegas from Hawaii in 2012.

Meanwhile, the exchange sent Basich premium invoices for January and February. He paid them both.

WHO CAN HELP?

Basich has sought help at virtually every level of the system, from the Xerox customer-service reps who answer the phones at the exchange's Henderson call center all the way to Gov. Brian Sandoval and Senate Majority Leader Harry Reid. Both Sandoval's and Reid's offices have told him they want to help, Basich said, but there's been no resolution so far.

Even Reid, who took flak for his Feb. 26 statement that “all” Obamacare “horror stories” are “untrue,” is trying to help. Reid spokeswoman Kristen Orthman said one of the senator's health-care legislative aides has been on the phone with Basich almost daily, “but at this point it's in the hands of Xerox to see what can be done.”

Sandoval spokesman Mac Bybee said the office “regularly engages” the exchange and Xerox on behalf of any consumer who reaches out with concerns about Nevada Health Link.

Officials with the Nevada Division of Insurance said they're also watching the situation.

“Mr. Basich's concerns are certainly on our radar. We have discussed them with our partners at the Silver State Health Insurance Exchange, and we feel confident that his concerns will soon be resolved appropriately,” division spokesman Jake Sunderland said.

But there hasn't been much action. What's more, when Burch discussed Basich's case with Xerox executives on March 11, they said they couldn't tell her much because the company had hired legal counsel. That's even though Basich has no interest in suing and has not retained a lawyer. He said he merely wants the exchange to keep the promise it made when it withdrew three premium payments from his savings account.

Xerox seems to be spending inordinate time documenting Basich's phone calls, website access and emails, Burch said. 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,'” Burch said.

“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,” she added.

Wasmer said there was nothing unusual about bringing in Xerox's attorneys.

“Our internal counsel is part of the extended Xerox team looking into the situation,” she said. “It's regular practice for a corporation to tap experts across its organization to best understand complicated issues like this one. We'll continue to keep the goal of resolving Mr. Basich's issue front and center as we work through its complexities.”

Though Basich's problem is exceptional for its dollar value, his situation is not unusual, Burch said. She estimates that of nearly 200 Branch Benefits Consultants client sign ups via Nevada Health Link, only 5 percent have gone through problem-free. More than 20 customers have the same plan-selection issue as Basich. One gave up trying to fix it and is sticking with the plan the exchange put her in.

With the March 31 enrollment deadline looming, Burch said she still sees other widespread enrollment problems, including frequent website error messages; inaccurate federal subsidy calculations; payments missing in the system despite clients' canceled checks; and wrong effective coverage dates. One client chose an effective coverage date of March 1. Her insurance card showed an effective date of Jan. 1. Burch said that when she called to fix the issue, a customer-service rep told her the system showed a start date of April 1.

Burch said her brokerage supports the Affordable Care Act and launched a department to sell exchange plans. But she said the experience is not what she or her clients hoped for.

“We think it's a great concept for those who need insurance. It's just unfortunate, with all of the roadblocks we're dealing with right now,” Burch said. “The bottom line is, we're talking about people. It's not a system, it's people. I think, somehow, Xerox forgot that.”

#politics

Comments 1 - 21 of 21        Search these comments

1   Ceffer   @   2014 Mar 18, 5:15am  

A glitch here, a glitch there. He can always still go bankrupt, like everybody in the past did before the Great Socialist Paradise intervened.

So that means that Obamacare left him with all options still open, just like fearless leader promised.

Why to they hate progress?

2   curious2   @   2014 Mar 18, 5:18am  

zzyzzx says

Basich said he began trying to enroll on Oct. 1, the day the exchange website went live. Like many consumers, he fought technical flaws during multiple sign-up attempts. In mid-November he finally got through and chose his plan: UnitedHealthcare’s MyHPNSilver1.

“It was like reaching the third level of Doom,” Basich said of the torturous sign-up process.

***

Though Basich’s problem is exceptional for its dollar value, his situation is not unusual, Burch said. She estimates that of nearly 200 Branch Benefits Consultants client sign ups via Nevada Health Link, only 5 percent have gone through problem-free. More than 20 customers have the same plan-selection issue as Basich. One gave up trying to fix it and is sticking with the plan the exchange put her in.

With the March 31 enrollment deadline looming, Burch said she still sees other widespread enrollment problems, including frequent website error messages; inaccurate federal subsidy calculations; payments missing in the system despite clients’ canceled checks; and wrong effective coverage dates. One client chose an effective coverage date of March 1. Her insurance card showed an effective date of Jan. 1. Burch said that when she called to fix the issue, a customer-service rep told her the system showed a start date of April 1.

Experiences like these may explain why opposition has actually widened since the legislation went into effect.

3   curious2   @   2014 Mar 18, 5:22am  

Basich should also be asking, did he really have a heart attack and did he really need the triple bypass? Now that more people have insurance with "no lifetime caps," more people are at risk for unnecessary bypass surgeries and other scams, which are tremendously lucrative. Many people don't understand, if you get an unnecessary bypass, you're much worse off than if you had done nothing at all: it puts you at risk for all sorts of lethal complications, and the bypass itself will probably need to be repeated every 10 years even if the first one was unnecessary.

4   curious2   @   2014 Mar 18, 5:28am  

APOCALYPSEFUCKisShostikovitch says

If the carrier who took his payments isn't Free to take this guy's premium payments and then get him to pay for every last cent of his care, Freedom has no meaning.

They did even better: they made him pay triple, because he was out of network.

5   lostand confused   @   2014 Mar 18, 5:39am  

APOCALYPSEFUCKisShostikovitch says

curious2 says



They did even better: they made him pay triple, because he was out of network.


I know you are a jolly joker but how can he be both un-covered and out of network?

Well apparantely with Obamacare-you can!! Yes you can!!!

6   curious2   @   2014 Mar 18, 5:54am  

APOCALYPSEFUCKisShostikovitch says

curious2 says

They did even better: they made him pay triple, because he was out of network.

I know you are a jolly joker but how can he be both un-covered and out of network?

Oh how I wish that I were joking.

In America, insurance works like a mafia protection racket. When an insurance company negotiates prices with an in-network provider, e.g. a hospital, it negotiates two types of prices.

The "in-network" price is what the provider will accept from the insurance company as "full payment." This is commonly the patient's "co-payment." The insurer acts as guarantor, i.e. the provider will get that $ even if you go bankrupt without making your co-payment. (And yes, as the experience of Massachusetts showed, plenty of people go bankrupt with medical bills they can't pay even if they have Obamneycare.)

The "out-of-network" price is what the provider agrees contractually to charge everyone else. It is commonly triple the in-network price. That is, in the insurance deal, you pay your protection money (called a premium) so that you don't have to pay the triple price, instead you pay only the co-payment (i.e., closer to the real price). Because Basich's insurer denies he was a customer, he gets the out-of-network (triple) price.

The actual real cost of whatever you receive, if you even needed that, can be found by comparing to other countries that don't have our system. Look across the border at Mexico, or look at India or Europe, and you'll get an idea of what things cost in reality. Everything above that is additional markup piled on by the American system. You can buy a car and TV made in Mexico, and food and clothing made in India, but Obamacare requires you to prepay for America's medical industrial complex and spends even more on border enforcement to stop you from buying medicine made elsewhere. Many people find, when they go to Mexcio, the total retail price is less than their American insurance co-payment.

Sadly, it's no joke.

7   anonymous   2014 Mar 18, 6:11am  

This is what the worthless democrats get for forcing republican legislation on the populace, and marrying themselves to it, for better or for worse.

We get worse, and worse, and worse

"But, insurance was so bad before obamacare, something had to be done!"

So something was done. Democrats assured that they could get something done. They could take a broken system, adopt republican policy, and prove that it could be made so much worse as to that people would be happy to have the old system back

8   Robber Baron Elite Scum   @   2014 Mar 18, 9:09am  

This is why assholes become doctors.

A medical license is a license granting the holder permission and authority to rape, pillage and destroy another human.

A doctor is a medical REALTOR.

9   Robert Sproul   @   2014 Mar 18, 10:42am  

curious2 says

unnecessary bypass, you're much worse off than if you had done nothing at all:

Also, they can prove no increase in longevity for bypass surgery.
And a few hours on the heart lung machine can cause severe cognitive impairment.
Witness Clintons daffiness after his surgery, they had to lock him away from the press.

10   Tenpoundbass   @   2014 Mar 18, 3:10pm  

Yeah but without Obamacare he would have had to file bankrupt.
Now that there's Obamacare, the IRS will make sure he pays his bill.

Now let's look out the window and take a look see how that Obamacare line coming along... MY Gawd it's practically empty, isn't there a Navigator or something they could send over to work, er I mean soothe this guy over?

11   elliemae   @   2014 Mar 22, 3:00am  

The affordable care act mandated that states either provide an exchange or make the federal exchange available in that state. Nevada, which is totally fucked up in its healthcare delivery, chose to provide its own exchange.

There are so many problems with the exchange, designed by Xerox, that the state is extending open enrollment for those people who started to sign up but couldn't finish, for another month. State administrators admit that this probably won't fix the problem. But I'm sure that they don't give a shit because they're all well insured. The people at Xerox are all well-insured and they don't need the assistance that the exchange would provide, so they're apathetic as well.

The ACA is not responsible for Nevada's failures. However, it's a lot easier for the sheeple to believe it's Obama's fault than to question why Xerox didn't create a viable exchange, and why it can't fix this issue. Nevada is throwing shitloads of money at the problem, yet they're not requiring results.

zzyzzx says

The help didn’t come fast enough, said Basich, who blames his back-and-forth with the exchange in December at least in part for stress that caused his heart attack.

That's a stretch. This guy blames the government for creating stress that, at least in part, led to his heart attack. He's 62 years old, from the photo doesn't appear to be in the greatest of health. Although the stress didn't help, it's probable that his cardiac issues existed long before he applied to the Nevada exchange.

It's just more fun for the press to run with this and blame "Obamacare" in the headlines, rather than to blame this rather prosperous state for the contractor it chose to provide the exchange and its response to the failure of a state contractor.

12   Tenpoundbass   @   2014 Mar 22, 12:31pm  

elliemae says

The ACA is not responsible for Nevada's failures.

Let me just tuck that away for a rainy day, when I've got nothing better to do than fucking fart out loud laughing when California's healthcare system implodes.

13   elliemae   @   2014 Mar 23, 3:11am  

CaptainShuddup says

Let me just tuck that away for a rainy day, when I've got nothing better to do than fucking fart out loud laughing when California's healthcare system implodes.

I'm glad that you enjoy and look forward to other people's failures. You're the kind of person we should all aspire to be - grumpy and with an inability to see past your anger. Perhaps you should go out to the garage and have some of that stuff that makes you so happy. Too bad that its still illegal in your conservative republican state.

At least you fit in.

14   justme   @   2014 Mar 23, 3:19am  

elliemae says

The ACA is not responsible for Nevada's failures. However, it's a lot easier for the sheeple to believe it's Obama's fault than to question why Xerox didn't create a viable exchange, and why it can't fix this issue. Nevada is throwing shitloads of money at the problem, yet they're not requiring results.

Amen.

15   justme   @   2014 Mar 23, 3:24am  

The debacle of Larry Basich is not the fault of the ACA. It is the fault of Xerox and United Health Care, who in turn tried to pawn Larry Basich's healthcare expenses onto Nevada Health CO-OP, a nonprofit.

So what we have here is very likely fraud. Xerox allowing United off the hook and trying to pass Basich onto Nevada Health CO_OP smells of fraud. Basich should get an attorney and force UHC to pay his bills.

This is no case for right-wing propagandist to make ACA look bad. We will call you out on YOUR lies.

xyz, you can start by correcting the absolute lie of a headline:

"Obamacare leaves Las Vegas man owing $407,000 in doctor bills".

16   Tenpoundbass   @   2014 Mar 23, 5:15am  

Cause and effect, stops at the Liberal door, and just ends where ever else it may.

When they crash the car, it's the wall's fault.

17   Tenpoundbass   @   2014 Mar 23, 5:19am  

A Federal law that covers health insurance, should still be able to dictate minimal standards.

Like if this guy did indeed logon and register but it is the websites fault, then I don't understand how the shortsighted cluster fuck that is the ACA, can't kick in and demand, that this guys story checks out. And if the server logs, does prove he did indeed log into the website and registered for ACA like he claims. Then regardless what the end result was, if the website can't produce proof that they notified him he was denied, then the insurance exchange should be on the hook for all of his medical bills.

I mean this is only simple Civil law, that if I had a website and offered paid services to you, I would be liable to pay up in any Civil court in the world.

Keep spinning excuses you Putsofbitches.

18   zzyzzx   @   2014 Mar 23, 11:28pm  

CaptainShuddup says

And if the server logs, does prove he did indeed log into the website and registered for ACA like he claims. Then regardless what the end result was, if the website can't produce proof that they notified him he was denied, then the insurance exchange should be on the hook for all of his medical bills.

I agree, but you are assuming that the developers of the website have enough common sense to log things in the first place.

19   marcus   @   2014 Mar 23, 11:47pm  

Before Obamacare, health insurance nightmares like this never happened.

Well, I'm not sure if they did or not, but I'm really sure they weren't big stories at Fox News like this is. Fox sure knows their audience. Hell, they program their audience.

http://www.foxnews.com/politics/2014/03/18/vegas-man-stuck-with-407000-medical-bill-after-obamacare-breakdown/

20   Tenpoundbass   @   2014 Mar 24, 12:19am  

zzyzzx says

I agree, but you are assuming that the developers of the website have enough common sense to log things in the first place.

All requests are logged somewhere. Or they could just ask the NSA they've been keeping minutes on the internet.

21   elliemae   @   2014 Mar 24, 1:51am  

Just provide coverage for all... problem solved.

Call it Crazy says

Hmmm... if Obamacare wasn't passed into law, the exchanges wouldn't of had to be created... The new law mandated a "vehicle" to process the applications... Nevada just chose a crappy contractor, but if not for the ACA, the exchange would have never existed...

If the Wright Brothers had never explored flight, Malaysia flight 370 might never have crashed. A replica of the Wright Brothers' plane "The Wright Flyer" is located in the Chicago Museum of Science and Industry. Obama lived in Chicago.

OMG!!!!! It's Obama's fault that this plane crashed!

(For all of you who are playing out there, Barack Obama & Tom Hanks appeared in the film "The Road We've Traveled." Tom Hanks and Kevin Bacon appeared together in the film, "Apollo 13.")

http://nbcpolitics.nbcnews.com/_news/2012/04/17/11250791-analysis-kevin-bacon-theory-of-politics-overtakes-2012-campaign?chromedomain=firstread&lite

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